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Samenvatting multifactoriële stoornissen 2 - dementie
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Inhoudsopgave1. inleiding.................................................................................................................................................................4
1.1. definitie...........................................................................................................................................................4
1.1.1. Definitie ASHA, 2019...............................................................................................................................5
1.1.2. Definitie A..J.; Rapidly Progressive Neurodegenerative Dementias.......................................................5
1.1.3. dsm v.......................................................................................................................................................5
1.1.4. dsm iv......................................................................................................................................................8
1.1.5. Expertisecentrum Dementie Vlaanderen................................................................................................9
1.2. Feiten over dementie...................................................................................................................................10
1.3. preventie en risicofactoren..........................................................................................................................10
1.4. cognitieve functies.......................................................................................................................................10
1.4.1. hersenlagen...........................................................................................................................................11
1.5. Geheugen en leren.......................................................................................................................................12
1.5.1. Inleiding.................................................................................................................................................12
1.5.2. geheugen...............................................................................................................................................12
1.5.3. Atkinson-Shiffrin geheugen model........................................................................................................13
1.5.4. het werkgeheugenmodel......................................................................................................................13
1.5.5. twee geheugens....................................................................................................................................14
1.5.6. het zintuiglijk geheugen (sensory memory)..........................................................................................15
1.5.7. het kortetermijngeheugen = werkgeheugen........................................................................................16
1.5.8. het langetermijngeheugen....................................................................................................................16
1.5.9. Onderscheid KTG en LTG.......................................................................................................................17
1.5.10. Impliciet geheugen:.............................................................................................................................17
1.6. Cognitie en geheugen communicatie..........................................................................................................18
1.6.1. cognitie-communicatie en algemene veroudering...............................................................................18
1.7. Zin/onzin van therapie.................................................................................................................................18
1.7.1. normale verouderingsprocessen...........................................................................................................19
1.7.2. Argumenten Pro therapie.....................................................................................................................19
1.8. Onze taak als logopedist..............................................................................................................................20
2. Onderliggende pathologieën...............................................................................................................................21
2.1. Mild cognitive impairment (MCI).................................................................................................................21
2.1.1. Definitie.................................................................................................................................................22
2.1.2. Onderscheid..........................................................................................................................................22
2.1.3. neuropathologie....................................................................................................................................22
2.1.4. algemene kenmerken...........................................................................................................................23
2.2. Dementie t.g.v. de ziekte van Alzheimer.....................................................................................................23
Multifactoriële stoornissen 2 Dementie Pagina 1 van 60
, 2.2.1. Atrofie, tangles en plaques...................................................................................................................23
2.2.2. 3 fasen...................................................................................................................................................24
2.2.3. Het verloop van de ziekte van Alzheimer.............................................................................................25
2.2.4. Voorbeeldcasus.....................................................................................................................................25
2.3. Dementie t.g.v. vasculaire dementie...........................................................................................................26
2.3.1. Het verloop van vasculaire dementie...................................................................................................26
2.3.2. Ziekte van Alzheimer en vasculaire dementie......................................................................................27
2.3.3. Voorbeeldcasus.....................................................................................................................................27
2.4. Dementie t.g.v. frontotemporale lobaire degeneratie................................................................................28
2.4.1. Subtypes................................................................................................................................................28
2.4.2. Voorbeeldcasus (gedragsvariant)..........................................................................................................29
2.5. Dementie t.g.v. Lewy Body dementie..........................................................................................................29
2.5.1. Kernsymptomen....................................................................................................................................29
2.6. Dementie t.g.v. Parkinson............................................................................................................................30
2.6.1. Primaire motorische symptomen.........................................................................................................30
2.6.2. Secunaidre motorische symptomen.....................................................................................................30
Lewy Body en ziekte van Parkinson................................................................................................................31
Voorbeeldcasus...............................................................................................................................................31
2.7. Dementie t.g.v. ziekte van Huntington........................................................................................................31
3. dementie-de 4 fasen van ik-beleving..................................................................................................................32
bedreigde ik.........................................................................................................................................................33
verdwaalde ik......................................................................................................................................................34
verborgen ik........................................................................................................................................................34
verzonken ik........................................................................................................................................................35
4. dementie – diagnostiek.......................................................................................................................................36
4.1. zin/onzin van een diagnose..........................................................................................................................36
4.2. diagnostisch proces......................................................................................................................................36
4.3. vraaggestuurde diagnostiek.........................................................................................................................38
4.4. anamnese.....................................................................................................................................................39
4.5. Neuropsychologisch onderzoek (NPO) versus cognitieve screening (CS)....................................................40
4.5.1. NPO (Neuropsychologisch onderzoek).................................................................................................40
4.5.2. CS (Cognitieve screening)......................................................................................................................40
4.6. rekening houden met:..................................................................................................................................40
4.7. Neuropsychologische testinstrumenten......................................................................................................41
4.7.1. Mini Mental State Examination = MMSE..............................................................................................42
4.7.2. Frontal Assessment Battery = FAB........................................................................................................42
4.7.3. Montreal Cognitive Assessment = MoCA..............................................................................................43
Multifactoriële stoornissen 2 Dementie Pagina 2 van 60
, 4.7.4. kloktekentest.........................................................................................................................................43
4.8. aanvullend onderzoek..................................................................................................................................44
4.9. diagnostiek taal............................................................................................................................................45
besluit..................................................................................................................................................................46
5. algemene benaderingswijzen..............................................................................................................................46
5.1. Realiteitsoriëntatie.......................................................................................................................................47
5.2. Validation.....................................................................................................................................................48
5.3. Adaptation-coping model.............................................................................................................................48
5.4. Warme zorg..................................................................................................................................................49
5.5. Persoonsgerichte belevingsgerichte zorg (person-centered care)..............................................................49
5.6. Geïntegreerde belevingsgerichte zorg.........................................................................................................50
6. Communicatietips...............................................................................................................................................51
6.1. Eigen attitude...............................................................................................................................................52
6.2. Wijze van spreken........................................................................................................................................52
6.3. Lichaamstaal.................................................................................................................................................52
6.4. Taalgebruik...................................................................................................................................................53
6.5. Omgevingsfactoren......................................................................................................................................53
7. Therapie en cognitieve interventie.....................................................................................................................53
7.1. Logopedie in de ouderenzorg......................................................................................................................53
7.2. Therapie........................................................................................................................................................54
7.2.1. MCI........................................................................................................................................................54
7.2.2. DIrecte en indirecte therapie................................................................................................................55
7.3. Principes van neuroplasticiteit binnen de directe therapie.........................................................................56
7.4. Reminiscentie...............................................................................................................................................57
7.4.1. Muziek...................................................................................................................................................57
7.5. Tips om een directe individuele therapie vorm te geven............................................................................58
7.5.1. Geheugentraining..................................................................................................................................58
7.5.2. Herhaling...............................................................................................................................................58
7.5.3. belang van advies en coaching..............................................................................................................59
7.5.4. Creëer communicatieve gelegenheden................................................................................................59
Multifactoriële stoornissen 2 Dementie Pagina 3 van 60
, DEMENTIE
1. INLEIDING
= Agentschap dat alles over dementie gaat bundelen
- Dementie Demens
o De = afwezigheid van
o Mens = verstand
afwezigheid van verstand
= mentale aandoening die de cognitieve vaardigheden gaat aantasten. Welke
cognitieve vaardigheden achteruit gaan is afhankelijk van het type dementie. Het gaat om
een degeneratieve aandoening. Het gaat achteruit, een volledig herstel zal nooit optreden.
- We zeggen niet ‘je bent dement, demente persoon, dementerende’, maar ‘iemand met dementie’
gebruik deze term op stage, examen…
- In de video kunnen we allerlei zaken opmerken:
o Gevoelens van angst, zich nutteloos voelen, frustraties, onmacht, paniek, agitatie, onrustig
zijn, wanen, …
o Afhankelijkheid
o Ze leeft in het verleden: ze denkt dat haar man nog steeds een jonge kerel is
o Bezig met de foto van Allison (zus of vriendin)
o Prosopagnosie: gezichten niet meer herkennen
o Objectagnosie: ze herkent tas koffie niet meer
o Desoriëntatie (ze vindt het toilet 20 minuten niet)
o Post-it van Amy waarbij ze Amy verwart met Allison
o Ze herkent zichzelf niet in foto’s
o Ze heeft over het algemeen problemen met de oriëntatie in tijd die zich zowel afspeelt in het
verleden en in het heden
o Ze weet niet meer waar ze is, ook ’s nachts is ze zeer verward
o Ze sprak woorden verkeerd uit
o Visuele perceptie is wat verstoord waardoor ook waanbeelden kunnen voorkomen
1.1. DEFINITIE
Multifactoriële stoornissen 2 Dementie Pagina 4 van 60
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