Early-Warning Signs of Serious Illness: What Caregivers Should Watch For

When something seems ‘off’ with a loved one, talk to their doctor to rule out whether it’s a sign of a major health issue

Paul Wynn,

AARP

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Published November 10, 2025

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Marianne Sciucco noticed her stepfather sleeping more, neglecting home chores and repeating stories. Once tidy and well-groomed, he grew disheveled and increasingly irritable, but family members dismissed it as just his personality. Rather than shrugging it off, Sciucco found that her nurse’s intuition was telling her something was seriously wrong.

Sciucco, a founder of AlzAuthors, a global community for authors who write about Alzheimer’s disease and dementia, sensed these behavior changes were more than mood swings — they were red flags. During visits to the home on Massachusetts’ Cape Cod, she saw how the house had fallen into disarray. Despite resistance from both her mom and her stepfather’s longtime physician, she persisted — documenting concerns, accompanying them to medical appointments and ultimately finding a new doctor who recognized the cognitive decline.

A comprehensive evaluation confirmed what Sciucco had suspected: Her stepfather had dementia, compounded by a brain injury at birth. The diagnosis was devastating, but her advocacy ensured he received proper care and protected her aging mother from being overwhelmed.

Reflecting on that time, Sciucco says, “As a nurse and a family member, I knew I couldn’t ignore the signs. When someone you love starts acting unlike themselves, you owe it to them to find out what’s really going on.”

Catching subtle health clues

Older adults frequently face significant delays in receiving diagnoses for chronic diseases, a problem that can profoundly affect treatment outcomes and quality of life. For conditions such as dementia, Parkinson’s disease, stroke and type 2 diabetes, a timely diagnosis is especially critical. It not only allows patients to access appropriate care and interventions that help maintain independence and quality of life but also supports families in planning and coping with the disease.

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Missed or delayed diagnoses can exacerbate disability, reduce the effectiveness of interventions and increase both caregiver burden and health care costs. Addressing these barriers through education, proactive screening and improved access to care is essential to reduce diagnostic delays and improve outcomes for older adults.

“The earlier you identify the signs, the earlier you can get a diagnosis, start treatment and get on a good course of care and therapy. It really behooves caregivers and patients to act as soon as possible,” says Dr. Caroline Tanner, vice chair for clinical research in the Department of Neurology at the UCSF Weill Institute for Neurosciences in San Francisco.

“Caregivers play such an important role in noticing early signs and getting loved ones evaluated. They often see subtle changes that patients themselves may not recognize,” Tanner says.

When changes signal something more

For Tracy Cram Perkins, the signs were there long before her father’s diagnosis — she just didn’t know what she was seeing. After caring for her mother, who developed dementia following cancer surgery, Perkins began to notice similar changes in her father: repeated stories, unpaid bills, flashes of uncharacteristic anger and unexplained dents on his car.

At first, she chalked it up to grief after her mother’s death. But over time the pattern was impossible to ignore.

Her father’s confusion deepened, and one day, he slipped into a diabetic coma— the crisis that finally led to a diagnosis of moderate Alzheimer’s disease. In retrospect, Perkins realized that the warning signs had been present for years. “I thought he was just tired or lonely,” she says. “Now I know those were the first signs of dementia.”

What followed was another painful discovery: In the care facility where her father lived, he was prescribed 38 medications — many of them conflicting, some making his diabetes and hallucinations worse. Once his drug regimen was corrected, his alertness and personality returned, at least for a time.

The experience turned Perkins into an advocate for early recognition and medication oversight. Her book, Dementia Home Care: How to Prepare Before, During, and After, helps families recognize subtle behavioral and physical changes before a crisis occurs.

Her message to other caregivers: “Spend time with your loved ones, pay attention to minor changes and trust your instincts. If something feels off, it probably is.”

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Dementia: early signs

Approximately 50 percent of older adults with dementia remain undiagnosed or receive a late diagnosis, according to one study. This delay is often due to misconceptions that memory loss is a normal part of aging, leading to missed opportunities for early intervention and care planning.

Detecting dementia and other cognitive disorders early can make a crucial difference in patient care, and caregivers often play a key role, says Dr. Doug Scharre, medical director of the Center for Cognitive and Memory Disorders at Ohio State University.

Scharre emphasizes the importance of one simple, annual question: “Over the last year, have you noticed any change in memory or thinking?” He notes that gradual changes like getting lost in familiar places, struggling to plan routines, forgetting names of objects or shifts in personality can signal the earliest stages of decline.

Caregivers, who often notice these subtle patterns before patients themselves, are encouraged to share observations with primary care physicians. Early reporting allows doctors to conduct cognitive assessments, rule out treatable issues such as medication side effects or sleep disorders, and, if needed, refer patients to specialists for more advanced testing.

Emerging tools like blood-based biomarkers show promise for Alzheimer’s, but spinal fluid analysis and specialized imaging remain the gold standard for other types of dementia.

Scharre stresses that early detection not only guides treatment but also gives families time to plan and prepare. “Caregivers are the first line of defense,” he says. “Noticing patterns early can change the trajectory of care and quality of life.”

Scharre highlights these early-warning signs of dementia:

Short-term memory loss
Difficulty finding words
Trouble with familiar tasks
Confusion about time or place
Poor judgment
Withdrawal from work or social activities
Mood or personality changes
Difficulty following conversations
Problems with spatial awareness
Misplacing items frequently

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Type 2 diabetes: early detection

Tammy Sirmons, a registered nurse and chief caregiving officer at Gracefully at Home Caregiving in Boynton Beach, Florida, says too many families miss the early-warning signs of chronic illnesses like type 2 diabetes because they dismiss gradual changes.

“Many people live with diabetes for years without knowing it,” says Sirmons. “They dismiss the constant thirst, the frequent urination, the weight gain and other warning signs.”

Unlike acute illnesses that come on suddenly and resolve quickly, chronic conditions develop slowly and can go undiagnosed for years. “People think it’s just getting older,” she says, “but some things that feel normal with age are actually warning signs.”

Sirmons notes that lack of regular health care access and skipped annual checkups allow many cases to go undetected until a crisis brings patients to the emergency room.

“You’d be surprised how many people first learn they have diabetes when they’re admitted for something else,” she says. Her advice: Caregivers should watch for small, ongoing changes and encourage loved ones to get regular bloodwork.

“Chronic diseases are like storms brewing,” she adds. “The signs are there — we just have to notice them before they hit.”

Sirmons identifies these early-warning signs of type 2 diabetes:

Increased thirst
Unexplained fatigue
Increased hunger
Frequent urination
Blurred vision
Slow-healing cuts or wounds
Frequent infections
Tingling or numbness in hands or feet
Darkened skin patches (acanthosis nigricans)
Unintended weight loss

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Stroke: What to know

Stroke remains a fast-moving and devastating medical emergency, says Dr. Alhamza al-Bayati, an endovascular neurosurgeon and vascular neurologist at the UPMC Stroke Institute in Pittsburgh. Nearly 800,000 Americans experience a stroke each year — that’s one every 40 seconds, according to a 2024 American Heart Association report. Although risk increases with age, strokes can affect anyone — including young adults and, in rare cases, children.

The leading modifiable risk factors, al-Bayati explains, are high blood pressure, high cholesterol, smoking and an inactive lifestyle. Uncontrolled high blood pressure damages blood vessels, making them prone to blockage or rupture.

Elevated cholesterol and smoking compound the damage, while sedentary habits and excessive alcohol use further increase risk. Atrial fibrillation, an irregular heartbeat common in people over 65, can lead to clots that travel to the brain.

Family history plays a significant role, al-Bayati says. Some people inherit genetic clotting disorders that make their blood “thicker,” predisposing them to stroke. Cancer and other underlying conditions can have similar effects.

“Every minute counts,” al-Bayati stresses — with nearly 2 million brain cells lost each minute that blood flow to the brain is blocked, researchers have calculated. Quick action dramatically improves outcomes: Emergency responders can administer clot-busting medication within three to four and a half hours of symptom onset or transport patients to specialized stroke centers for surgical clot retrieval.

While access to advanced stroke care can vary between urban and rural areas, telemedicine has closed many of those gaps. Local hospitals can now connect instantly with stroke specialists to start treatment, even before transferring patients to larger centers.

“The bottom line,” says al-Bayati, “is that stroke is a preventable and treatable emergency, but only if people recognize the signs and act fast.”

When it comes to warning signs, al-Bayati urges everyone to remember the acronym BE FAST, developed by Duke Health, to expand on the previous public awareness FAST campaign:

B – Balance: sudden loss of balance or coordination
E – Eyes: blurred or double vision, or sudden loss of sight in one or both eyes
F – Face drooping: Does one side of the face droop or is there an uneven smile?
A – Arm weakness: numbness or weakness in one arm or side of the body
S – Speech difficulty: slurred or confused speech
T – Time: Call 911 immediately

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Paul Wynn, a veteran health care writer, has spent over a decade immersed in the caregiving community, both as a family caregiver and as a journalist covering caregiving issues for national publications.