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Samenvatting Klinische Neuropsychologie (17/20 eerste zit!)
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  • Course
  • Klinische neuropsychologie (004371)
  • Institution
  • Vrije Universiteit Brussel (VUB)

Deze samenvatting is een volledige samenvatting van het vak klinische neuropsychologie gedoceerd door professor K. Beeckmans en E. Dierckx . Het wordt gegeven in eerst jaar master aan de VUB. De samenvatting omvat de slides aangevuld met uitgebreide lesnota's van het academiejaar .

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Document information

  • January 11, 2024
  • 190
  • 2023/2024
  • Summary

Subjects

  • waarneming
  • ruimtelijke cognitie
  • aandacht
  • executieve functies
  • sociale cognitie
  • cva
  • actie en
  • historische inleiding en situering
  • traumatisch herstel neuropsychologie
  • frontale hersenkwab neuropsychologie

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  • Vrije Universiteit Brussel (VUB)
  • Psychologie
  • Klinische neuropsychologie (004371)
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Klinische Neuropsychologie

Inhoudsopgave

H1: Historische inleiding en situering ..................................................................................................................... 8
1 Situering .................................................................................................................................................................................................. 8
1.1 Definitie .................................................................................................................................................................................... 8
1.2 Cognitieve functies en stoornissen ............................................................................................................................... 9
1.3 Ziektebeelden......................................................................................................................................................................... 9
2 Historische inleiding .......................................................................................................................................................................... 9
2.1 Oudheid ................................................................................................................................................................................... 9
2.2 Oude Egypte......................................................................................................................................................................... 10
2.3 Egypte..................................................................................................................................................................................... 10
2.4 Arabische wereld............................................................................................................................................................... 10
2.5 Grieken en Romeinen ...................................................................................................................................................... 11
2.5.1 Grieken.......................................................................................................................................................................... 11
2.6 Celtheorie (Ventriculaire lokalisatie hypothese) ................................................................................................ 12
2.7 Renaissance ......................................................................................................................................................................... 13
2.8 Eind 16e, 17e en begin 18e eeuw ............................................................................................................................... 13
2.9 19e eeuw ............................................................................................................................................................................... 14
2.10 20ste eeuw......................................................................................................................................................................... 15
2.11 Midden 20e eeuw ........................................................................................................................................................... 16
2.12 Hedendaagse neuropsychologie .............................................................................................................................. 16
2.12.1 Vier belangrijke concepten ............................................................................................................................... 17
2.12.2 België .......................................................................................................................................................................... 18
2.12.3 Werkplaatsen neuropsycholoog ..................................................................................................................... 18

H2: (Visuele) Waarneming ........................................................................................................................................ 20
1 Inleiding................................................................................................................................................................................................. 20
2 Visuele waarneming......................................................................................................................................................................... 20
2.1 Fysiologie: van het oog naar de hersenen .............................................................................................................. 20
2.2 Fysiologie: visuele cortex............................................................................................................................................... 21
2.3 Stadia in de visuele waarneming (functioneel).................................................................................................... 22
2.4 Stoornissen na hersenbeschadiging.......................................................................................................................... 24
2.4.1 Apperceptieve objectagnosie .............................................................................................................................. 24
2.4.2 Kopiëren bij associatieve objectagnosie ........................................................................................................ 25
2.5 Lagere orde stoornissen ................................................................................................................................................. 25
2.5.1 visueel veld defect.................................................................................................................................................... 25
2.5.2 stoornissen in gezichtsscherpte, contrastgevoeligheid en licht-donkeradaptatie ...................... 27
2.5.3. stoornissen in de kleurwaarneming ............................................................................................................... 27
2.5.4. stoornissen in de bewegingswaarneming .................................................................................................... 27
2.6 Hogere orde stoornissen ................................................................................................................................................ 28
2.6.1 Apperceptieve agnosieën...................................................................................................................................... 28
2.6.2 Associatieve agnosieën .......................................................................................................................................... 28
2.6.3 Prosopagnosie ........................................................................................................................................................... 29



1

, 2.7 Overige visuele stoornissen .......................................................................................................................................... 29
2.7.1 Blindsight ..................................................................................................................................................................... 29
2.7.2 Visuele illusies en hallucinaties ......................................................................................................................... 30
2.7.3 Corticale blindheid .................................................................................................................................................. 30
2.7.4 Palinopsie .................................................................................................................................................................... 30
3 Auditieve waarneming .................................................................................................................................................................... 30
3.1 Fysiologie: van het oor naar de hersenen ............................................................................................................... 30
3.2 Auditieve stoornissen...................................................................................................................................................... 31
4 Tactiele waarneming / lichamelijke perceptie .................................................................................................................... 31
4.1 Perceptie: stoornissen..................................................................................................................................................... 31
5 Smaak en reukperceptie ................................................................................................................................................................. 32
5.1 Stoornissen .......................................................................................................................................................................... 32

6 VIsuele waarneming tests → niet actief kennen ........................................................................................................... 32

H3: Ruimtelijke cognitie............................................................................................................................................. 34
1 Inleiding................................................................................................................................................................................................. 34
1.1 Ruimtelijke perceptie ...................................................................................................................................................... 34
1.2 Ruimtelijke aandacht ....................................................................................................................................................... 34
1.3 Ruimtelijke representaties ............................................................................................................................................ 35
1.4 Ruimtelijk geheugen ........................................................................................................................................................ 35
1.4.1 Werkgeheugen .......................................................................................................................................................... 36
1.4.2 Objectrelaties ............................................................................................................................................................. 36
1.4.3 Het leren van een route ......................................................................................................................................... 37
1.5 Visuoruimtelijke praxis .................................................................................................................................................. 37
2 Ruimtelike cognitie stoornissen na hersenbeschadiging ................................................................................................. 37
2.1 Ruimtelijke perceptie ...................................................................................................................................................... 37
2.2 Ruimtelijke aandacht ....................................................................................................................................................... 38
2.3 Ruimtelijk geheugen ........................................................................................................................................................ 41
2.4 Ruimtelijke praxis ............................................................................................................................................................. 42

3 Diagnostiek → niet actief kennen ........................................................................................................................................... 43
3.1 Ruimtelijke cognitie ......................................................................................................................................................... 43
3.2 Visuoruimtelijke praxis .................................................................................................................................................. 43
3.3 Perceptie ............................................................................................................................................................................... 44
3.4 Visueel-ruimtelijk werkgeheugen: tests ................................................................................................................. 46

H4: Aandacht, executieve functies en sociale cognitie ..................................................................................... 47
1 Aandacht ............................................................................................................................................................................................... 47
1.1 Selectiviteit van aandacht .............................................................................................................................................. 47
1.1.1 Gerichte aandacht .................................................................................................................................................... 47
1.1.2 Verdeelde aandacht................................................................................................................................................. 48
1.2 Intensiteit van aandacht ................................................................................................................................................. 49
1.2.1 Alertheid ...................................................................................................................................................................... 49
1.2.2 Volgehouden aandacht .......................................................................................................................................... 49
1.3 Neuro-anatomische correlaten ................................................................................................................................... 50
1.3.1 Betrokken hersengebieden .................................................................................................................................. 50
2 Executieve functies ........................................................................................................................................................................... 50
2.1 Paraplubegrip ..................................................................................................................................................................... 51


2

, 2.2 Lokalisatie ............................................................................................................................................................................ 51
2.3 Stoornissen .......................................................................................................................................................................... 52
2.3.1 Aandacht en executieve functies ....................................................................................................................... 52
3 Sociale cognitie .................................................................................................................................................................................. 53
3.1 Emotionele processen ..................................................................................................................................................... 53
3.2 Emoties .................................................................................................................................................................................. 53
3.3 Sociaal-cognitieve processen ....................................................................................................................................... 55
3.4 Stoornissen .......................................................................................................................................................................... 55
3.4.1 Oorzaken ...................................................................................................................................................................... 55
3.5 Lokalisatie in het brein ................................................................................................................................................... 56
1 Neuraal herstel ................................................................................................................................................................................... 57
1.1 Neuroplasticiteit ................................................................................................................................................................ 57
1.2 Inleiding ................................................................................................................................................................................ 57
1.2.1 Herstelcurve ............................................................................................................................................................... 57
1.2.2 Twee herstelfasen .................................................................................................................................................... 58
1.3 De acute fase ........................................................................................................................................................................ 58
1.3.1 Oedeem ......................................................................................................................................................................... 58
1.3.2 Neurale shock ............................................................................................................................................................ 59
1.3.3 Diaschisis (functionele deactivering) .............................................................................................................. 59
1.4 De adaptatiefase ................................................................................................................................................................ 60
1.4.1 Lokale reorganisatie (neurofysiologische adaptatie)............................................................................... 60
1.4.2 Functionele adaptatie ............................................................................................................................................. 66
1.4.3 Neurale bypass .......................................................................................................................................................... 66
1.4.4 Redundantie (‘unmasking’) ................................................................................................................................. 67
1.5 Factoren die het neuraal herstel beïnvloeden ...................................................................................................... 68
1.5.1 Cognitive reserve...................................................................................................................................................... 69
1.5.2 Breinreserve ............................................................................................................................................................... 70
2 Neuropsychologische revalidatie ............................................................................................................................................... 70
2.1 Begrippenkader ................................................................................................................................................................. 72
2.1.1 Cognitieve revalidatie ............................................................................................................................................ 72

H6: Neuropsychologie van cerebrovasculaire aandoeningen ....................................................................... 80
1 Bloedvatensysteem (Arteriële circulatie) ............................................................................................................................... 80
2 CVA........................................................................................................................................................................................................... 81
2.1 Inleiding → niet kennen voor het examen .............................................................................................................. 81
2.2 Risicofactoren ..................................................................................................................................................................... 81
2.2.1 Wijzigbare of behandelbare risicofactoren................................................................................................... 81
2.2.2 Niet-wijzigbare risicofactoren ............................................................................................................................ 81
2.3 CVA .......................................................................................................................................................................................... 82
2.3.1 Ischemisch CVA ......................................................................................................................................................... 82
2.3.2 Hemorragisch CVA ................................................................................................................................................... 88
2.3.3 Overzicht CVA-types ............................................................................................................................................... 92
2.4 Problemen na een CVA.................................................................................................................................................... 92
2.4.1 lichamelijke problemen ......................................................................................................................................... 92
2.4.2 neuromotorische problemen .............................................................................................................................. 94
2.4.3 neuropsychologische problemen ...................................................................................................................... 95

H7: Neuropsychologie van traumatisch herstel ................................................................................................. 99




3

, 1 Inleiding................................................................................................................................................................................................. 99
1.1 Incidentie en oorzaken ................................................................................................................................................... 99
2 Traumatisch hersenletsel .............................................................................................................................................................. 99
2.1 Classificatie op basis van het hersenletsel ...........................................................................................................100
2.1.1 Post-commotioneel syndroom .........................................................................................................................101
2.1.2 Whiplash letsel ........................................................................................................................................................101
2.1.3 Verschillen licht traumatisch hersenletsel en whiplash letsel ...........................................................102
2.1.4 Verklaring voor het post-commotioneel syndroom ...............................................................................102
2.1.5 Open schedelletsel .................................................................................................................................................103
2.1.6 Gesloten schedelletsel ..........................................................................................................................................104
2.1.7 Coup en contre-coup / open en gesloten schedelletsel .........................................................................104
2.1.8 Coma (‘loss of consciousness’ (LOC)) ............................................................................................................104
2.1.9 Post-traumatische amnesie (PTA) ..................................................................................................................105
2.2 Pathofysiologie: Primaire en secundaire letsels ................................................................................................107
2.2.1 primaire letsels .......................................................................................................................................................107
2.2.2 Secundaire letsels ..................................................................................................................................................109
2.3 Chronisch traumatisch encefalopathie (CTE) .....................................................................................................111
2.4 Neuropsychologische problemen na een contusio cerebri ...........................................................................111
2.4.1 cognitieve stoornissen .........................................................................................................................................111
2.4.2 emotionele veranderingen .................................................................................................................................112
2.4.3 gedragsveranderingen .........................................................................................................................................113
2.4.4 anosognosie ..............................................................................................................................................................113

H8: Neuropsychologie van de frontale hersenkwab...................................................................................... 114
1 Inleiding.............................................................................................................................................................................................. 114
1.1 Anatomie en functionele organisatie ......................................................................................................................114
1.2 Drie schorsen (cortices) ...............................................................................................................................................115
1.2.1 Drie controlerende functies ...............................................................................................................................116
1.3 De prefrontale cortex kan verdeeld worden in 3 verschillende gebieden ............................................116
2 Primaire motorische cortex ....................................................................................................................................................... 117
2.1 Motorische functies ........................................................................................................................................................117
3 Premotorische cortex.................................................................................................................................................................... 119
3.1 Motorische functies ........................................................................................................................................................119
4 Area van broca ................................................................................................................................................................................ 120
4.1 Taalfuncties........................................................................................................................................................................120
4.1.1 Casus leborgne (‘Tan’) (1809 - 1861) ...........................................................................................................120
5 Frontale oogbewegingszone...................................................................................................................................................... 120
5.1 Visuoperceptuele functies ...........................................................................................................................................120
5.1.1 Experiment van Yarbus .......................................................................................................................................120
5 Prefrontale cortex .......................................................................................................................................................................... 121
5.1 Een letsel van de prefrontale cortex kan resulteren in...................................................................................121
5.1.1 Aandachtsstoornissen in de prefrontale cortex........................................................................................121
5.1.2 Geheugenstoornissen prefrontale cortex ....................................................................................................124
5.1.3 Executieve stoornissen prefrontale cortex .................................................................................................127
5.1.4 Emotionele en gedragsveranderingen prefrontale cortex ...................................................................131

H9: Taal ......................................................................................................................................................................... 133
1 Taal als cognitie .............................................................................................................................................................................. 134



4

, 1.1 Mentale lexicon ................................................................................................................................................................134
1.2 De gesproken taal ............................................................................................................................................................135
1.2.1 Begrijpen van de gesproken taal .....................................................................................................................135
1.2.2 Produceren van taal ..............................................................................................................................................135
2 Stoornissen in taal ......................................................................................................................................................................... 136
2.1 Stoornissen in de taalproductie ................................................................................................................................136
2.1.1 Woordvindingsproblemen .................................................................................................................................136
2.1.2 Problemen in de zinsbouw.................................................................................................................................137
2.2 Stoornissen in het taalbegrip .....................................................................................................................................137
2.2.1 Problemen op klank- en woordniveau..........................................................................................................137
2.2.2 Problemen op zinsniveau ...................................................................................................................................137
2.3 Afasie ....................................................................................................................................................................................138
2.3.1 Afasie van Broca .....................................................................................................................................................138
2.3.2 Afasie van Wernicke .............................................................................................................................................138
2.3.3 Conductie-afasie .....................................................................................................................................................139
2.3.4 Transcorticale afasie .............................................................................................................................................139
2.3.5 Globale afasie ...........................................................................................................................................................139
2.3.6 Amnestische afasie / anomische afasie ........................................................................................................139
2.3.7 Samenvattend schema .........................................................................................................................................140
2.4 Afasie: hersengebieden .................................................................................................................................................140
2.5 Spraakstoornissen ..........................................................................................................................................................143
2.6 Lees- en schrijfstoornissen .........................................................................................................................................143
2.6.1 Leesstoornissen ......................................................................................................................................................143
2.6.2 Schrijfstoornissen ..................................................................................................................................................144
3 Diagnostiek stoornissen in taal ................................................................................................................................................ 144
3.1 Tests ......................................................................................................................................................................................145

H10: Actie en motoriek ............................................................................................................................................ 146
1 Motoriek ............................................................................................................................................................................................. 146
1.1 Organisatie van het motorisch systeem ................................................................................................................146
1.1.1 Neuro-anatomisch .................................................................................................................................................146
1.2 Representatie van bewegingen .................................................................................................................................147
1.2.1 Spiegelneuronen ....................................................................................................................................................147
1.2.2. Forward models.....................................................................................................................................................148
1.2.3. Motorische planning ............................................................................................................................................148
1.2.4. Motor imagery ........................................................................................................................................................148
1.3 Representatie van bewegingsdoelen ......................................................................................................................149
1.3.1. Externe representatie .........................................................................................................................................149
1.3.2. Interne representatie ..........................................................................................................................................149
2 Motorische stoornissen ................................................................................................................................................................ 149
2.1 Rubberenhandillusie .....................................................................................................................................................149
2.2 Cerebrale parese (CP) ...................................................................................................................................................150
2.3 Apraxie .................................................................................................................................................................................150
2.3.1 Ideationele apraxie ................................................................................................................................................150
2.3.2 Ideomotorische apraxie.......................................................................................................................................151
2.3.3 Andere indelingen..................................................................................................................................................151
2.4 Alien hand syndrome.....................................................................................................................................................152
2.5 Anarchic hand syndrome (AHS) ...............................................................................................................................152
3 Samenvatting ................................................................................................................................................................................... 153



5

, H11: Geheugen............................................................................................................................................................ 154
1 Inleiding.............................................................................................................................................................................................. 154

2 Taxonomie van het geheugen→ Structuren / systemen en processen ........................................................ 154
2.1 Sensorisch geheugen, korte termijn geheugen & lange termijn geheugen ............................................155
2.1.1 Uitdieping KTG ........................................................................................................................................................156
2.1.2 uitdieping werkgeheugen ...................................................................................................................................157
2.1.3 Geheugenprocessen ..............................................................................................................................................158
2.1.4 Uitdieping declaratief lange termijngeheugen ..........................................................................................161
2.1.5 Uitdieping niet-declaratief lange termijngeheugen ................................................................................164
2.2 Geheugen en brein → niet actief kennen ..........................................................................................................165
2.2.1 Werkgeheugen ........................................................................................................................................................165
2.2.2 Episodisch geheugen (amnestisch syndroom)..........................................................................................165
2.2.3 Opslaan van nieuwe herinneringen ...............................................................................................................165
2.2.4 Niet declaratief lange termijn geheugen ......................................................................................................165
3 Cognitie en gezond ouder worden .......................................................................................................................................... 166
4 Stoornissen ........................................................................................................................................................................................ 166
4.1 Geheugenklacht................................................................................................................................................................167
4.2 Amnesie en amnestisch syndroom ..........................................................................................................................167
4.3 Oorzaken van geheugenstoornissen .......................................................................................................................167
4.3.1 Neurodegeneratieve aandoeningen ...............................................................................................................167
4.3.2 Korsakoff syndroom .............................................................................................................................................174
4.3.3 Posttraumatische amnesie .................................................................................................................................174
4.3.4 Transient global amnesie....................................................................................................................................174
4.3.5 Functionele / psychogene amnesie ................................................................................................................175
4.3.6 Psychiatrische aandoening: depressie ..........................................................................................................175

H12: Epilepsie en Intra- en extracraniële tumoren ....................................................................................... 176
1 Epilepsie ............................................................................................................................................................................................. 176
1.1 Omschrijving .....................................................................................................................................................................176
1.2 Definitie ...............................................................................................................................................................................176
1.3 Pathofysiologie van de epileptische aanvallen ...................................................................................................176
1.3.1 Classificatie ...............................................................................................................................................................177
1.4 Behandeling .......................................................................................................................................................................180
1.4.1 Anti-epileptica .........................................................................................................................................................180
1.4.2 Neurocirurgische behandeling .........................................................................................................................181
1.4.3 Nervus vagusstimulatie .......................................................................................................................................182
1.4.4 Deep brain stimulatie ...........................................................................................................................................182
1.4.5 Katogeen dieet .........................................................................................................................................................182
1.5 Neuropsychologische gevolgen.................................................................................................................................183
1.5.1 Type epilepsie ..........................................................................................................................................................183
1.5.2 Netwerktheorie .......................................................................................................................................................183
1.5.3 Antiepileptica ...........................................................................................................................................................184
1.6 Cognitief functioneren: bijwerkingen ....................................................................................................................184
1.6.1 Intelligentie ...............................................................................................................................................................184
1.6.2 Geheugen ...................................................................................................................................................................184
1.6.3 Snelheid van informatieverwerking ..............................................................................................................184
1.6.4 Aandacht en executief functioneren ..............................................................................................................184
1.6.5 Taal en spraak..........................................................................................................................................................184



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