Dementia is robbing me of my family. How can I best cope?

Sorry to hear you've had such a bad year. I can really sympathise. My mother died eight years ago after ten miserable years suffering from vascular dementia, and I'm now looking after a friend just nine years older than myself, who has the same condition.

I too am an only child, and I could get no help whatever for my mother, as she'd always lived in social housing, so had no house to sell to pay for her care. I didn't live with her throughout this time, although she was alone, my father having died of cancer ten years before the onset of her illness. Although I never married or had children, I'd left home at the age of 20 and made my own life. By the time my mother started going downhill I'd got a mortgage and a career of sorts, and was living 200 miles away from her.

We both went through ten years of hell, during which I lost several jobs through constantly having to drop everything and run home. During this time my mother, who'd always been somewhat reclusive, turned her back on all her friends. Literally, in the case of one poor, faithful old lady who used to visit every day and sit stoically staring at my mother's back when she turned her chair to face away from her. She finally died after three long months in a series of hospitals and - as you say - found peace.

And now a friend has the same condition, unfortunately overlaid with a severe psychosis (which can occasionally happen in dementia). Having started out in a lovely old people's home, where she unfortunately pushed the head nurse down the stairs and stabbed a frail resident, she's now incarcerated in a grim psycho-geriatric facility, where she's wasting away. As with my mother, anxiety seems to be a major component of her illness.

That's my story - mainly to establish my credentials, I suppose. And also to get it off my chest a bit. Thanks for listening, if you did!

The point I'd like to make may not be a very reassuring one, though I still think it's necessary to make it. Looking back over the lives of both my mother and my friend, I can see that both were consumed by anxiety and obsessive, control-freak behaviour even when they were young. These days, when we all live so long, any of us can be struck down with some form of dementia, and I'm convinced that those of us who haven't addressed our personality issues - and particularly anxiety - during our youth often suffer the most.

I don't really know how you can help your mother with her anxiety. If you're 32, I'm guessing she must already be around 60. If the anxiety is a short-term thing, a reaction to your grandmother's death, medication might help. CBT would be even better if it's available in your area. (I'm guessing from your use of the word "Nan" that you're in the UK, though I could be wrong.) Would she agree to see her GP and ask about this? My mother flatly refused to discuss anxiety issues with anyone, but then yours is a generation younger than mine, which could make a difference.

More to the point, how are you coping? You don't say anything about your own situation and I'm wondering whether you're living with your mother, which will make everything harder for you. All I can say from personal experience is that it's important not to withdraw from your own life and friends.

And don't worry about occasionally forgetting words. That happens to all of us. Especially me - but it worries me rather more since I'm already past 70! Vascular dementia, of the type your grandfather seems to have, doesn't run in families. Alzheimer's can, but it's not a very dominant gene, so having a grandmother with the condition doesn't mean a great deal. In any case, until just a few years ago it wasn't possible to diagnose it during life, so "Alzheimer's" was used as a catch-all to describe all kinds of dementia, even by doctors. A lot of people with the diagnosis actually had some other kind of dementia. All dementias of old age have the same symptoms. (I can say this with some authority, as I'm a former nurse, specialised in neuro.)

Harsh as it might sound, I really think you have to look after yourself first and foremost. If you get sucked into the spiral of your mother's anxiety you won't be able to support either her or your grandfather. Don't get anxious about your own forgetfulness, which is a normal symptom of your current anxiety. You're not going to develop Alzheimer's at age 32! I know it's sad to effectively lose both your grandparents. That's the great tragedy of all dementias - we lose our loved ones twice. Another way to look at it is that you had them during your childhood, which is actually something of a modern phenomenon. Both my grandfathers died when I was a child, one grandmother when I was in my teens and the second when I was in my 20s... and I'm barely two generations older than you. Neither of my parents even knew their grandparents, which was relatively normal for their generation.

Now that's enough of my old-lady ramblings. Please take care of yourself first. If you can deal with your own anxieties and learn to carry on living, you'll be much more able to help your mother and grandfather.