NHG-Richtlijnen
NHG-Standaard
M21
5.0
april 2020
april 2020
P. Psychische problemen

Richtlijnen diagnostiek

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Stap 1: Signaleren

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Stap 2: Diagnostiek

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(Hetero)anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Evaluatie

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Criteria voor de diagnose dementie

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Oorzaken van dementie

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Stap 3: Inventarisatie van de zorgbehoefte

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Richtlijnen beleid

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Voorlichting en advies

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Voorlichting over de diagnose

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Voorlichting aan de mantelzorger

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Niet-medicamenteuze behandeling

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Patiënt 

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Mantelzorger 

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Medicamenteuze behandeling

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Cholinesteraseremmers en memantine

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Controles

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Aandachtspunten

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Consultatie en verwijzing

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Verwijsindicaties voor aanvullende diagnostiek en/of behandeling

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Verwijsmogelijkheden voor ziekte- en zorgdiagnostiek

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Probleemgedrag bij dementie

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Crisissituaties

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Medicamenteuze behandeling in crisissituaties

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Mild cognitive impairment (MCI)

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Samenwerking en afstemming

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Achtergronden

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Epidemiologie

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Incidentie en prevalentie van dementie

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Prevalentie van oorzaken van dementie

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Mengvormen
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Prevalentie van dementie bij niet-westerse migranten

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Etiologie en pathofysiologie

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Ziekte van Alzheimer

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Vasculaire dementie

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Parkinsondementie

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Lewy-body-dementie (LBD)

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Frontotemporale dementie

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Cardiovasculaire risicofactoren

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Prognose

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Richtlijnen diagnostiek

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Stap 1: Signaleren

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Signalen van dementie

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Signalen bij jonge patiënten

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Signaleringstests

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Stap 2: Diagnostiek

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Hulpvraag vaststellen

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Patiënten met cognitieve klachten
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Patiënten zonder hulpvraag
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Uitvoering van de diagnostiek
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(Hetero)anamnese

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Algemene vragen
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Vragen gericht op symptomen van dementie
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Vragen gericht op andere oorzaken
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Vragen gericht op medicatiegebruik
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Overige vragen
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Heteroanamnese
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Lichamelijk onderzoek

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Onderzoek gericht op symptomen van dementie
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Onderzoek gericht op andere oorzaken van geheugenproblemen
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Neurologisch onderzoek
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Aanvullend onderzoek

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Laboratoriumonderzoek
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Beeldvormend onderzoek
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Mini-Mental State Examination (MMSE)
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Kloktekentest
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Rowland Universal Dementia Assessment Scale (RUDAS)
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Montreal Cognitive Assessment (MoCA)
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Evaluatie

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Criteria voor de diagnose dementie
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Differentiaaldiagnose
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Oorzaken van dementie
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Patiënten die niet voldoen aan de criteria voor dementie
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Stap 3: inventarisatie van de zorgbehoefte

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Volhoudtijd mantelzorger

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Mishandeling

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Richtlijnen beleid

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Voorlichting en advies

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Voorlichting over de diagnose

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Overige voorlichting aan patiënt en mantelzorger

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Voorlichting aan de mantelzorger

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Thuisarts

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Overige voorlichting

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Rijgeschiktheid

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Advance care planning (ACP)

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Niet-medicamenteuze behandeling

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Patiënt

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Dagbesteding of dagbehandeling
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Mantelzorger

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Medicamenteuze behandeling

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Cholinesteraseremmers en memantine

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Voedingssupplementen en andere farmacotherapeutische middelen

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Individueel zorgplan (IZP)

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Controles

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Aandachtspunten

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Planning van zorg

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Consultatie en verwijzing

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Organisatie van zorg

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Lokale netwerken
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Huisartsenpost
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Casemanager dementie
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Specialist ouderengeneeskunde, klinisch geriater, neuroloog, ouderenpsychiater
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Kaderhuisarts ouderengeneeskunde
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Ouderenpsycholoog
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Overige disciplines
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Verwijsindicaties voor aanvullende diagnostiek en/of behandeling

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Verwijsmogelijkheden voor ziekte- en zorgdiagnostiek

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Verwijsbrief

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Samenwerkingsafspraken rond verwijzing

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Opname in een instelling

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Wet langdurige zorg (Wlz)
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Wet verplichte geestelijke gezondheidszorg (Wvggz) en Wet zorg en dwang (Wzd)
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Probleemgedrag bij dementie

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Definitie

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Hoofdvormen van probleemgedrag

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Methodische aanpak in 6 fasen

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Fase 1 Beschrijving en verheldering
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Fase 2 Onderzoek
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Fase 3 Probleemdefinitie
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Fase 4 Behandeldoel
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Fase 5 Behandelplan
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Fase 6 Evaluatie 
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Crisissituaties

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Medicamenteuze behandeling in crisissituaties
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