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My dad is main caregiver for my mom, but needs my help in getting to appts and for advice. They've been using her cardiologist as her primary doctor - on the last visit ( prompted by a pimple like sore on her behind; she sits a lot, is afraid to fall even with her walker) he recommended a psychiatrist. She's been getting more anxious and won't sleep the whole night if my dad isn't right by her. She hasn't been formally diagnosed with vascular dementia but she had a series of TIAs more than 2 years ago - she's been having more language difficulties and confusion since then. Do we start with the psych (actually seeing their psych nurse practitioner) he recommended? no one in the practice is a geriatric psych specialist. Or should we see a geriatric medicine specialist first? I'm worried that she might be diabetic. I've read so many articles but I feel like I'm having the "paralysis of anaylsis" that athletes talk about!

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I took my loved one to a General practitioner first. She did a mini test in the office and diagnosed dementia. She also referred her to a Neurologist who did tests and ordered an MRI and a neurological exam.
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I can't imagine going to see a cardiologist about a sore on the behind, hardly his level of expertise and a waste of his advanced training. This is why I prefer to deal with a general practitioner, at your mom's age that could be a geriatric medicine specialist. They would be able to coordinate the care of all her conditions, and perhaps cut down on the number of trips to multiple specialists for each separate issue. If they feel there is a need for a psych evaluation you can go ahead with that later.
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