Hoorcollege 1 Neuropsychologische Diagnostiek 2023 Universiteit Utrecht
Hoorcollege 1
Neuropsychologische diagnostiek: in kaart brengen van functiestoornissen bij hersenbeschadiging. Bestaat uit observeren, anamnese, weergavegesprek en rapportage binnen de neuropsychologie.
Indicaties van neuropsychologische diagnostiek
- Neurologische aandoening: beroerte, tumor, traumatisch hersenletsel etc.
- Psychiatrische stoornissen: schizofrenie, bipolaire stoornis etc.
- Ontwikkelingsstoornissen: dyslexie, ADHD, autisme etc.
- Veroudering en dementie
Diagnostisch proces
- Anamnese en heteroanamnese
- Vraagstelling en hypothesevorming
- Testselectie en testafname
- Observatie
- Interpretatie
- Schriftelijke en mondelinge rapportage
Casuïstiek: 71 jarige vrouw met hersentumor in linker pariëtale kwab
- Vraagstelling: Het doel is om het cognitief functioneren in kaart te brengen voor monitoring tijdens een wakkere resectie van de tumor. Dit leidt tot de vraag "Is er een valide baseline voor monitoring tijdens de operatie?”
- Hypothesen: Over welke cognitieve functies aangedaan zijn bvb visuoperpceptie-, taal-, geheugen-, aandachtsproblemen. Middels (hetero-)amanese, NPO, observatie kan dit worden aangepast op de patiënt. Casus had moeite met douchen, woordvindproblemen, preservatie (doorzetting), begrip van testinstructies etc
- Test: patiënt had problemen met de volgende zaken
conductiepraxie: problemen met het imiteren van bewegingen, terwijl het pantomime van de beweging redelijk intact is
ideomotorische apraxie: begrip van de opdracht, maar onvermogen tot uitvoering bvb gedag zwaaien
Moeite met hogere orde taken met vormen en kleuren. Losse herkenning lukt, maar het uitvoeren van “leg de rode cirkel op de witte rechthoek” niet
Kleursortering. Dit ging goed, maar de wijze waarop was afwijkend van de norm
Fouten bij de boston naming task
- Conclusie: Uit het NPO komt vooral de taalstoornis naar voren zowel taalbegrip als taalproductie lukken niet zo goed meer. Ook zijn er stoornissen in de fijne motoriek van de rechterhand, proprioceptie van rechts, de praxis en de visuoconstructie. Het (non-verbaal) geheugen is intact en er is sprake van ziektebesef en (gedeeltelijk) ziekte-inzicht. Het was aan de hand van de tests mogelijk om de geplande wakkere RIP links pariëtaal uit te voeren met deze patiënt.
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