Samenvatting van het Nederlandse boek voor klinische neuropsychologie van de bachelor psychologie op de Radboud universiteit voor het tentamen voor Brein en Cognitie 2: Clinical Neuropsychologie
Inhoudsopgave
Neuropsychologie in de praktijk..................................................................................................................... 5
Inleiding................................................................................................................................................................5
Werkveld...............................................................................................................................................................5
Ziekenhuis........................................................................................................................................................5
Geestelijke gezondheidszorg............................................................................................................................6
Revalidatie........................................................................................................................................................6
Langdurige zorg................................................................................................................................................6
Forensische zorg..............................................................................................................................................7
Specialistische centra.......................................................................................................................................7
Alcoholgerelateerde cognitieve stoornissen................................................................................................... 8
Inleiding................................................................................................................................................................8
Alcoholgerelateerde cognitieve stoornissen........................................................................................................9
Acute effecten van alcoholmisbruik.....................................................................................................................9
Hersenschade bij chronisch alcoholgebruik.........................................................................................................9
Neurologische gevolgen van chronisch alcoholmisbruik...................................................................................10
Oorzaken van de neurologische en neuropsychologische gevolgen van chronisch alcoholmisbruik.................10
Neurotoxiciteit...............................................................................................................................................10
De continuïteitshypothese: meer drinken meer schade?.............................................................................10
Gecompliceerd gebruik van alcohol: comorbide aandoeningen met neurologische gevolgen....................10
Foetaal alcohol syndroom..............................................................................................................................11
Wernicke-encefalopathie....................................................................................................................................12
Syndroom van Korsakov.....................................................................................................................................12
De cognitieve stoornissen bij het syndroom van Korsakov................................................................................13
Geheugen.......................................................................................................................................................13
Visueel-ruimtelijke en executieve functies....................................................................................................13
Intelligentie....................................................................................................................................................14
Sociale cognitie..............................................................................................................................................14
Neuropsychiatrische symptomen..................................................................................................................14
Alcoholdementie.................................................................................................................................................15
De ziekte van Alzheimer............................................................................................................................... 16
Dementie............................................................................................................................................................16
Algemene info Alzheimer...................................................................................................................................16
Klinische diagnose Alzheimer........................................................................................................................16
Licht cognitieve stoornissen (MCI)......................................................................................................................17
Diagnostische criteria MCI.............................................................................................................................17
Epidemiologie.....................................................................................................................................................18
Etiologie en neuropathologie.............................................................................................................................18
Plaques en tangles.........................................................................................................................................18
Amyloïd-cascade-hypothese..........................................................................................................................18
Vasculaire hypothese.....................................................................................................................................18
Hypotheses gecombineerd............................................................................................................................19
Risicofactoren................................................................................................................................................19
Klinisch en neurologisch profiel..........................................................................................................................19
, Klinisch beloop...............................................................................................................................................19
Meetinstrumenten:............................................................................................................................................20
Het cognitieve profiel van alzheimerdementie..................................................................................................20
Globaal profiel klinisch verloop alzheimerdementie..........................................................................................21
Boek...............................................................................................................................................................21
Slides..............................................................................................................................................................22
Veranderingen in de hersenen in kaart brengen................................................................................................22
Structurele beeldvorming..............................................................................................................................22
Elektro-encefalogram (eeg)...........................................................................................................................23
FDG-PET.........................................................................................................................................................23
Liquordiagnostiek (ruggenprik)......................................................................................................................23
Verschillende verschijningsvormen....................................................................................................................23
Posterieure corticale atrofie (PCA)................................................................................................................23
Logopene afasie.............................................................................................................................................23
Disexecutieve variant.....................................................................................................................................24
Alzheimer op jonge leeftijd............................................................................................................................24
Verwante stoornissen: neuropsychiatrische symptomen.............................................................................24
Medicamenteuze behandeling...........................................................................................................................24
Cholineteraseremmers..................................................................................................................................24
Memantine....................................................................................................................................................25
Normale cognitieve veroudering........................................................................................................................25
Vasculaire cognitieve stoornissen................................................................................................................. 25
Inleiding..............................................................................................................................................................25
Normale bloedsomloop naar het brein..............................................................................................................25
Epidemiologie.....................................................................................................................................................26
Etiologie herseninfarct en hersenbloeding.........................................................................................................26
Herseninfarct.................................................................................................................................................26
Transient Ischemic Attack (TIA) en lacunair infarct........................................................................................27
Hersenbloeding..............................................................................................................................................27
Acute en chronische gevolgen............................................................................................................................28
Neuropsychologische gevolgen..........................................................................................................................29
Vasculaire risicofactoren, cerebral small vessel disease................................................................................29
Tia en lacunair infarct....................................................................................................................................29
Stroomgebied van de arteria cerebri media (ACM).......................................................................................30
Stroomgebied van de arteria cerebri posterior (PCA)...................................................................................31
Stroomgebied van de arteria cerebri anterior (ACA).....................................................................................32
Subcorticale infarcten....................................................................................................................................32
Vasculaire dementie (VaD).............................................................................................................................34
Niet cognitieve gevolgen....................................................................................................................................34
Angst en depressie.........................................................................................................................................34
Multiple sclerose......................................................................................................................................... 35
Wat is MS...........................................................................................................................................................35
Wisselende symptomen:...............................................................................................................................35
Stappen ontwikkeling....................................................................................................................................36
Laesies............................................................................................................................................................36
Epidemiologie................................................................................................................................................36
Risicofactoren................................................................................................................................................36
, Neurologische symptomen.................................................................................................................................37
Gevolgen in het dagelijks leven.....................................................................................................................38
Ziekteverloop......................................................................................................................................................38
Levensverwachting........................................................................................................................................39
Diagnose.............................................................................................................................................................39
Behandeling........................................................................................................................................................39
Corticosteroïden............................................................................................................................................39
Ziektemodificerende therapieën...................................................................................................................40
Symptomatische therapieën:.........................................................................................................................40
Cognitie..............................................................................................................................................................40
Geheugen.......................................................................................................................................................40
Problemen met taal.......................................................................................................................................41
Slechtere cognitieve uitkomst voor:..............................................................................................................41
Meting van cognitie.......................................................................................................................................41
Rol van psycholoog........................................................................................................................................41
Hypothesen ontstaan MS...................................................................................................................................42
Outside-in-hypothese....................................................................................................................................42
Inside-out-hypothese.....................................................................................................................................42
Epilepsie...................................................................................................................................................... 42
Klinisch beeld......................................................................................................................................................42
Epilepsie en epileptische aanvallen...............................................................................................................42
Classificatie van epileptische aanvallen en epilepsie.....................................................................................42
Etiologie epilepsie...............................................................................................................................................45
Epidemiologie.....................................................................................................................................................46
Neuropsychologische gevolgen van epilepsie....................................................................................................48
Etiologie neuropsychologische stoornissen bij epilepsie..............................................................................48
Cognitie..........................................................................................................................................................49
Psychiatrische stoornissen.............................................................................................................................51
Psychosociale aspecten.................................................................................................................................52
Het Parkinsonspectrum................................................................................................................................ 52
Epidemiologie.....................................................................................................................................................52
Klinisch beeld......................................................................................................................................................53
Motorische stoornissen.................................................................................................................................53
Niet motorische symptomen.........................................................................................................................54
Twee subtypes...............................................................................................................................................55
Meten.............................................................................................................................................................55
Etiologie.........................................................................................................................................................55
Neuropathologie............................................................................................................................................56
Diagnostiek.........................................................................................................................................................57
Parkinsonismen..............................................................................................................................................57
Behandeling........................................................................................................................................................58
Cognitieve stoornissen.......................................................................................................................................59
Klinisch beeld.................................................................................................................................................59
Parkinsondementie en DLB............................................................................................................................60
Atypische parkinsonismen.............................................................................................................................61
Diagnostiek van cognitieve stoornissen (MCI en dementie).........................................................................61
Neuropsychiatrische stoornissen...................................................................................................................61
,Plasticiteit, herstel en neuropsychologische revalidatie................................................................................62
,Neuropsychologie in de praktijk
Inleiding
Psycholoog is een science practicioner = combineren klinische kennis en vaardigheden met
wetenschappelijke grondhouding
Evidence based medicine = beslissingen van de neuropsycholoog zijn gebaseerd op bewijzen
vanuit wetenschappelijk onderzoek, klinische expertise en behoeften van de patiënt.
Neuropsychologisch onderzoek is klinisch wetenschappelijk onderzoek met n=1
Werkveld
Ziekenhuis
Soorten ziekenhuizen:
Normaal ziekenhuis
Categoraal ziekenhuis
Ziekenhuis speciaal voor een doelgroep (epilepsie/kanker)
Academisch ziekenhuis
Zorg
Wetenschappelijk onderzoek
Contact met universiteit
Kenmerken:
Patiëntengroep heeft (vermoedelijke) medische aandoening waarbij direct of indirecte
cognitieve klachten zijn ontstaan.
Veelal diagnostisch werk
Kortdurende behandelingen
Leren omgaan met stoornis, verbeteren stemming en oppakken activiteiten
Neuropsychologische onderzoek
o Cognitief, emotioneel en gedragsmatig functioneren in kaart brengen en impact
van de gevolgen van cognitieve stoornissen in kaart brengen.
Arts eindverantwoordelijke
Samenwerking met medische specialisten en paramedici
, Geestelijke gezondheidszorg
Veel psychiatrische aandoeningen die effect hebben op cognitief functioneren.
Kenmerken
Snijvlak psychiatrie en neurologie
Cognitieve klachten oorzaak psychiatrische stoornis of neurologisch probleem
Uitgebreide diagnostiek
Lange behandeling
Neuro psychiatrisch model
o Relatie tussen hersenen, cognitie, emotie en gedrag
Neuropsycholoog eindverantwoordelijke
Samenwerking met casemanagers
Revalidatie
Kenmerken:
Multidisciplinaire aanpak
Samenwerking met heel behandelteam
Participatie van patiënten
Proberen patiënten weer zo veel mogelijk zelfstandig deel te kunnen laten nemen aan
de maatschappij
Diagnostiek heeft al plaatsgevonden
Inzicht geven in leefbaarheid van patiënt
Reden stagnatie achterhalen
Rekening houden beste behandelwijze patiënt
Patiënten betrokken bij behandeltraject.
Langdurige zorg
Kenmerken:
Patiënten kunnen niet meer zelfstandig thuis wonen door cognitieve stoornissen
Ouderen met neurodegeneratieve ziekten of patiënten met ernstig hersenletsel
Psychogeriatrische afdelingen
o Patiënten met verschillende vormen van dementie die constante zorg nodig
hebben
Samenwerken met verzorgers
Meer behandeling en begeleiding dan diagnose
Veel mediatieve behandeling
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