GEESTELIJKE GEZONDHEIDSZORG
DEEL PSYCHOGERIATRIE
,Inhoud
Hoofdstuk 1: Inleiding en dementie algemeen................................................................................................6
1.1 Inleiding...........................................................................................................................................................6
1.1.1 Oorzaken van de vergrijzing.....................................................................................................................6
1.1.2 Enkele cijfers…..........................................................................................................................................6
1.1.3 Conclusie..................................................................................................................................................7
1.2 Dementie.........................................................................................................................................................7
1.2.1 Wanneer is er sprake van dementie?......................................................................................................7
1.2.2 Verloop van dementie..............................................................................................................................7
1.2.3 Specifieke stoornissen bij dementie........................................................................................................8
Hoe werkt ons geheugen?.................................................................................................................................8
Geheugenschema..............................................................................................................................................8
Wat zien we bij dementie.................................................................................................................................9
Oriëntatiestoornissen........................................................................................................................................9
Afasie, apraxie en agnosie...............................................................................................................................10
Executieve stoornissen....................................................................................................................................10
Stoornissen in eigen lichaamsschema.............................................................................................................10
Aanvullende stoornissen.................................................................................................................................10
1.2.4 Indeling van dementie............................................................................................................................11
1.2.5 Verloop van dementie............................................................................................................................12
Hoofdstuk 2: Ziekte van Alzheimer............................................................................................................... 12
2.1 Inleiding.........................................................................................................................................................12
2.2 Oorzaken.......................................................................................................................................................12
2.3 Verloop..........................................................................................................................................................13
2.4 Stadia in het ziekteverloop............................................................................................................................13
Eerste stadium.................................................................................................................................................13
tweede stadium...............................................................................................................................................14
derde stadium.................................................................................................................................................15
2.5 Diagnostiek....................................................................................................................................................15
2.6 Behandeling...................................................................................................................................................15
2.7 Medicatie.......................................................................................................................................................16
2.8 ZVA en erfelijkheid........................................................................................................................................16
2.8.1 Christine van Broeckhoven.....................................................................................................................16
,Hoofdstuk 3: Vasculaire dementie................................................................................................................ 17
3.1 Acute gevolgen..............................................................................................................................................17
3.2 Algemene kernmerken..................................................................................................................................17
3.3 Andere complicaties......................................................................................................................................17
3.4 Diagnostiek....................................................................................................................................................17
3.5 DSM IV criteria...............................................................................................................................................18
3.5 Behandeling...................................................................................................................................................18
3.6 Besluit............................................................................................................................................................18
Hoofdstuk 4: Lewy Body Dementie............................................................................................................... 18
4.1 Inleiding (ntk)................................................................................................................................................18
4.2 Wat zijn lewy-bodies?...................................................................................................................................19
4.2.1 Lewy Bodies............................................................................................................................................19
4.3 Klinisch beeld.................................................................................................................................................19
4.4 Diagnostiek....................................................................................................................................................20
4.5 Behandeling...................................................................................................................................................20
Hoofdstuk 5: Fronto–temporale dementie (ntk)........................................................................................... 20
5.1 Symptomen...................................................................................................................................................21
5.2 Behandeling...................................................................................................................................................21
Hoofdstuk 6: Dementie ten gevolge van de ziekte van Parkinson (ntk)..........................................................22
6.1 Ontstaan........................................................................................................................................................22
6.2 Symptomen...................................................................................................................................................22
6.3 Behandeling...................................................................................................................................................23
Hoofdstuk 7: Huntington dementie - Chorea van Huntington (ntk)...............................................................23
6.1 Inleiding.........................................................................................................................................................23
6.2 Ontstaan........................................................................................................................................................23
6.3 Symptomen...................................................................................................................................................24
Hoofdstuk 8: Depressie bij ouderen.............................................................................................................. 25
8.1 Cijfers.............................................................................................................................................................25
8.2 Wat is depressie?..........................................................................................................................................25
8.3 Symptomen...................................................................................................................................................25
8.4 Vormen van depressie...................................................................................................................................25
8.5 Risicogroep....................................................................................................................................................25
8.5.1 Risicofactoren.........................................................................................................................................26
8.6 Herkennen van depressie..............................................................................................................................27
8.7 Omgaan met depressie voor ouderen..........................................................................................................28
8.8 Behandeling van depressie bij ouderen........................................................................................................30
8.9 Assessment....................................................................................................................................................30
, 8.10 Zelfdoding bij ouderen................................................................................................................................30
8.10.1 Situatie in Vlaanderen (De Standaard, dec. 2010)...............................................................................31
8.10.2 Hoe kunnen we anticiperen vanuit het beleid op dit groeiende probleem?......................................31
8.10.3 Waarom suïcide ?.................................................................................................................................31
8.10.4 Signalen................................................................................................................................................32
Hoofdstuk 9: Psychose bij ouderen............................................................................................................... 32
9.1 Inleiding.........................................................................................................................................................32
9.2 Psychose bij ouderen....................................................................................................................................32
9.2.1 Wat is nu een psychose (bij ouderen)?..................................................................................................33
9.3 Symptomen...................................................................................................................................................35
9.4 oorzaak..........................................................................................................................................................35
9.5 omgaan met ouderen met psychose............................................................................................................36
9.5.1 Valkuilen.................................................................................................................................................37
9.5.2 Wat doen we wel?..................................................................................................................................38
Hoofdstuk 10: Psycho-educatie.................................................................................................................... 41
10.1 wat is psycho-educatie?..............................................................................................................................41
10.2 Voor wie psycho-educatie...........................................................................................................................41
10.3 Over wat wordt er informatie gegeven.......................................................................................................41
10.4 Meerwaarde................................................................................................................................................42
10.5 Voorbeelden psycho-educatie....................................................................................................................42
10.5.1 Verslavingsproblematiek......................................................................................................................42
1.5.2 twee delen van psychoeducatie.............................................................................................................45
10.5.3 Aandachtspunt bij depressie................................................................................................................45
Hoofdstuk 11: Omgaan met ouderen met dementie.....................................................................................46
11.1 Realiteitsoriëntatietraining - ROT...............................................................................................................46
11.1.1 Doelen..................................................................................................................................................46
11.1.2 Basishouding........................................................................................................................................47
11.1.3 Toepassingsmodaliteiten.....................................................................................................................47
11.2 Belevingsgerichte benadering.....................................................................................................................49
11.2.1 Doel......................................................................................................................................................49
11.2.2 Beleving................................................................................................................................................50
11.2.3 Uitganspunten......................................................................................................................................50
11.2.4 Voorwaarden om belevingsgericht te werken.....................................................................................50
10.2.5 Basisprincipes.......................................................................................................................................51
11.2.6 Verloop van dementie volgens Rien Verdult.......................................................................................51
11.2.6 Belangrijke aspecten binnen de benadering........................................................................................52
11.3.7 Hoe de gesprekstechnieken inpassen in de verschillende stadia? (ntk).............................................52
DEEL PSYCHOGERIATRIE
,Inhoud
Hoofdstuk 1: Inleiding en dementie algemeen................................................................................................6
1.1 Inleiding...........................................................................................................................................................6
1.1.1 Oorzaken van de vergrijzing.....................................................................................................................6
1.1.2 Enkele cijfers…..........................................................................................................................................6
1.1.3 Conclusie..................................................................................................................................................7
1.2 Dementie.........................................................................................................................................................7
1.2.1 Wanneer is er sprake van dementie?......................................................................................................7
1.2.2 Verloop van dementie..............................................................................................................................7
1.2.3 Specifieke stoornissen bij dementie........................................................................................................8
Hoe werkt ons geheugen?.................................................................................................................................8
Geheugenschema..............................................................................................................................................8
Wat zien we bij dementie.................................................................................................................................9
Oriëntatiestoornissen........................................................................................................................................9
Afasie, apraxie en agnosie...............................................................................................................................10
Executieve stoornissen....................................................................................................................................10
Stoornissen in eigen lichaamsschema.............................................................................................................10
Aanvullende stoornissen.................................................................................................................................10
1.2.4 Indeling van dementie............................................................................................................................11
1.2.5 Verloop van dementie............................................................................................................................12
Hoofdstuk 2: Ziekte van Alzheimer............................................................................................................... 12
2.1 Inleiding.........................................................................................................................................................12
2.2 Oorzaken.......................................................................................................................................................12
2.3 Verloop..........................................................................................................................................................13
2.4 Stadia in het ziekteverloop............................................................................................................................13
Eerste stadium.................................................................................................................................................13
tweede stadium...............................................................................................................................................14
derde stadium.................................................................................................................................................15
2.5 Diagnostiek....................................................................................................................................................15
2.6 Behandeling...................................................................................................................................................15
2.7 Medicatie.......................................................................................................................................................16
2.8 ZVA en erfelijkheid........................................................................................................................................16
2.8.1 Christine van Broeckhoven.....................................................................................................................16
,Hoofdstuk 3: Vasculaire dementie................................................................................................................ 17
3.1 Acute gevolgen..............................................................................................................................................17
3.2 Algemene kernmerken..................................................................................................................................17
3.3 Andere complicaties......................................................................................................................................17
3.4 Diagnostiek....................................................................................................................................................17
3.5 DSM IV criteria...............................................................................................................................................18
3.5 Behandeling...................................................................................................................................................18
3.6 Besluit............................................................................................................................................................18
Hoofdstuk 4: Lewy Body Dementie............................................................................................................... 18
4.1 Inleiding (ntk)................................................................................................................................................18
4.2 Wat zijn lewy-bodies?...................................................................................................................................19
4.2.1 Lewy Bodies............................................................................................................................................19
4.3 Klinisch beeld.................................................................................................................................................19
4.4 Diagnostiek....................................................................................................................................................20
4.5 Behandeling...................................................................................................................................................20
Hoofdstuk 5: Fronto–temporale dementie (ntk)........................................................................................... 20
5.1 Symptomen...................................................................................................................................................21
5.2 Behandeling...................................................................................................................................................21
Hoofdstuk 6: Dementie ten gevolge van de ziekte van Parkinson (ntk)..........................................................22
6.1 Ontstaan........................................................................................................................................................22
6.2 Symptomen...................................................................................................................................................22
6.3 Behandeling...................................................................................................................................................23
Hoofdstuk 7: Huntington dementie - Chorea van Huntington (ntk)...............................................................23
6.1 Inleiding.........................................................................................................................................................23
6.2 Ontstaan........................................................................................................................................................23
6.3 Symptomen...................................................................................................................................................24
Hoofdstuk 8: Depressie bij ouderen.............................................................................................................. 25
8.1 Cijfers.............................................................................................................................................................25
8.2 Wat is depressie?..........................................................................................................................................25
8.3 Symptomen...................................................................................................................................................25
8.4 Vormen van depressie...................................................................................................................................25
8.5 Risicogroep....................................................................................................................................................25
8.5.1 Risicofactoren.........................................................................................................................................26
8.6 Herkennen van depressie..............................................................................................................................27
8.7 Omgaan met depressie voor ouderen..........................................................................................................28
8.8 Behandeling van depressie bij ouderen........................................................................................................30
8.9 Assessment....................................................................................................................................................30
, 8.10 Zelfdoding bij ouderen................................................................................................................................30
8.10.1 Situatie in Vlaanderen (De Standaard, dec. 2010)...............................................................................31
8.10.2 Hoe kunnen we anticiperen vanuit het beleid op dit groeiende probleem?......................................31
8.10.3 Waarom suïcide ?.................................................................................................................................31
8.10.4 Signalen................................................................................................................................................32
Hoofdstuk 9: Psychose bij ouderen............................................................................................................... 32
9.1 Inleiding.........................................................................................................................................................32
9.2 Psychose bij ouderen....................................................................................................................................32
9.2.1 Wat is nu een psychose (bij ouderen)?..................................................................................................33
9.3 Symptomen...................................................................................................................................................35
9.4 oorzaak..........................................................................................................................................................35
9.5 omgaan met ouderen met psychose............................................................................................................36
9.5.1 Valkuilen.................................................................................................................................................37
9.5.2 Wat doen we wel?..................................................................................................................................38
Hoofdstuk 10: Psycho-educatie.................................................................................................................... 41
10.1 wat is psycho-educatie?..............................................................................................................................41
10.2 Voor wie psycho-educatie...........................................................................................................................41
10.3 Over wat wordt er informatie gegeven.......................................................................................................41
10.4 Meerwaarde................................................................................................................................................42
10.5 Voorbeelden psycho-educatie....................................................................................................................42
10.5.1 Verslavingsproblematiek......................................................................................................................42
1.5.2 twee delen van psychoeducatie.............................................................................................................45
10.5.3 Aandachtspunt bij depressie................................................................................................................45
Hoofdstuk 11: Omgaan met ouderen met dementie.....................................................................................46
11.1 Realiteitsoriëntatietraining - ROT...............................................................................................................46
11.1.1 Doelen..................................................................................................................................................46
11.1.2 Basishouding........................................................................................................................................47
11.1.3 Toepassingsmodaliteiten.....................................................................................................................47
11.2 Belevingsgerichte benadering.....................................................................................................................49
11.2.1 Doel......................................................................................................................................................49
11.2.2 Beleving................................................................................................................................................50
11.2.3 Uitganspunten......................................................................................................................................50
11.2.4 Voorwaarden om belevingsgericht te werken.....................................................................................50
10.2.5 Basisprincipes.......................................................................................................................................51
11.2.6 Verloop van dementie volgens Rien Verdult.......................................................................................51
11.2.6 Belangrijke aspecten binnen de benadering........................................................................................52
11.3.7 Hoe de gesprekstechnieken inpassen in de verschillende stadia? (ntk).............................................52
