This is the one warning sign of Alzheimer’s that people mistake for a character flaw and it actually breaks my heart

Alzheimer’s is a horrible disease that has uniquely devastating effects on sufferers and their loved ones.

Affecting approximately 72 million Americans firsthand, common symptoms include memory loss; struggles to plan, complete tasks or solve problems; feeling confused; faces new problems with speaking and writing; wrong parts; making poor judgment calls; social withdrawal; and more.

Although these are the symptoms we often hear about, they are not the only ones. There is one symptom that many caregivers are unaware of and believe is a result of “bad” caregiving: restlessness.

“It is critical to first appreciate that agitation is a symptom of brain changes caused by Alzheimer’s disease, not poor care,” said Dr. Richard Stefanacci, medical director of Inspira LIFE, a senior living program.

“Brain damage from Alzheimer’s makes people prone to agitation, no matter how loving the caregivers are,” said Stefanacci, who also specializes in older populations and Alzheimer’s disease.

According to information provided by the Alliance of Aging Research to HuffPost, “fidgeting” in this regard can present itself in a variety of ways: pacing, trying to leave, tantrums, swearing, hitting, mood swings, throwing objects, and more. Caregivers may blame themselves, the AAR continued, believing it to be a result of their exhaustion, the introduction of a new routine or a lack of patience.

Dr. Nikhil Palekar, director of Stony Brook Alzheimer’s Center of Excellence at Stony Brook Medicine, said there is a stigma when it comes to this specific symptom.

“Caregivers often feel they may be doing something wrong, causing their loved one with Alzheimer’s to react in an uncooperative, hostile or agitated manner, not realizing that agitation in Alzheimer’s disease is very common, with rates ranging from 56% in early stages to 68% in moderate-severe disease,” he said.

How Alzheimer’s can cause symptoms of agitation

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As with other Alzheimer’s symptoms, it all comes down to the brain.

“Alzheimer’s disease is the result of brain damage in areas of the brain that control emotions, decision-making and behavioral responses,” Stefanacci said. “This neurological damage explains why people with Alzheimer’s can react strongly to situations that would not have bothered them before the disease progressed to this point.”

More specifically, we look at neurotransmitters. “Alzheimer’s disease results in a dysregulation and decrease in three neurotransmitters (chemical messengers) in the brain — serotonin, norepinephrine and dopamine — leading to symptoms of agitation,” Palekar said. Considering that these neurotransmitters help with mood, motivation, energy, anxiety and more, this makes sense.

We also need to consider environmental factors. For example, the holiday season – or other high-stress events – can exacerbate restlessness and its causes.

“Large gatherings with unfamiliar faces, disrupted routines, unfamiliar foods, and changes in previously familiar environments can cause agitation in someone with Alzheimer’s, especially [in] later stages of the disease,” Stefanacci continued. “The most important thing is to make adjustments and accommodations to reduce stress, such as maintaining routine and familiarity.”

There is hope for Alzheimer’s agitation

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Whether you’re struggling with Alzheimer’s or love someone who has it, know that hope is not lost. Below, doctors share tips and other helpful information that can help you manage this symptom together:

Create and maintain routines.

Consistent daily schedules with meals, activities and bedtime are key, according to Stefanacci. When you need to prepare your loved one for a change, he encourages doing it ahead of time if/when you can and trying to maintain other routines.

Avoid arguing when possible.

If the person with Alzheimer’s has a harmless belief, Stefanacci advised not to argue with them about it. Rather, he said to focus on the emotion behind what they’re saying and remember that you can’t reason with an Alzheimer’s brain.

Use calming approaches.

Although sometimes difficult, it is important to stay calm and help the person with Alzheimer’s stay calm. Speak in a calm, soothing voice, play familiar music he likes, and reduce confusing noise, Stefanacci said.

Know that there are helpful treatments available.

It’s easy to feel hopeless when someone has Alzheimer’s and to think that small interventions won’t make a difference. That’s understandable – and thankfully not true.

“This symptom can be effectively treated with behavioral interventions as well as medications, which are FDA-approved for the treatment of agitation in Alzheimer’s disease,” Palekar said.

To get to that point, he recommended discussing any agitation-like symptoms with the patient’s doctor.

Similar to the tips above, Palekar listed some specific, non-pharmacological interventions that can also reduce agitation:

• Maintaining a daily routine and structure

• Reducing noise and clutter

• Walking (ideally outside in the sunlight)

• Stay busy with distractions such as snacks, objects, or fun activities

• Avoiding stimulants, such as caffeine, late in the day.

Take care of yourself as a caregiver.

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Being a carer is hard work, don’t underestimate it. Stefanacci urges these people to seek support from other caregivers, support groups and counseling. He also mentioned giving yourself permission to simplify or skip holiday traditions that are just too overwhelming.

In short, it’s “normal” for someone with Alzheimer’s to show agitation—and that’s because of the Alzheimer’s disease, not anything the caregiver did. As a person with Alzheimer’s or a loved one, know that you are not alone and that people are available and willing to support you.

This article originally appeared on HuffPost.

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