What is a typical day with mild cognitive impairment?

For years Bob worried something was wrong with his memory. He expressed this worry to his family physician, who told him loss of memory is a normal part of aging. Bob explained that “all these years that I’ve known that something was going on in my brain, I can see a curve. It’s always been a pretty steady curve going slowly downhill.”

What Bob was experiencing was not normal aging. He was diagnosed with Mild Cognitive Impairment (MCI). The term describes measurable deficits in cognition that, although annoying, do not cause disability. For some patients, MCI may be the earliest sign of Alzheimer’s disease. Those patients with MCI will eventually develop dementia.¹ Along with eleven other patients with MCI from the University of Pennsylvania’s Memory Center, in 2015, Bob participated in the “Typical Day” photo-elicitation project. Patients were given cameras and asked to photograph images of their everyday life that frustrate, facilitate, or challenge their memory (Image 1). Using photos as a tool to encourage conversation, our team conducted in-depth interviews with participants.²

For Bob, as for all “Typical Day” project participants, interpersonal relationships—especially those with close family—were both centrally important and challenging. One family member joined an interview and expressed how her spouse “was a very outgoing, gregarious person who was able to interact in groups or one on one, but he is not able to do that anymore,” adding that “I often have to remind him how to behave in social situations. It’s been very difficult for me.”

These social challenges can contribute to stigma and shame for people experiencing MCI. Bob explained: “Let’s say we’re going to go to a cocktail party, I worry about that because I walk into a room where I should know most of the people there. I’ve known them for years, and I’m in a point now where I will not be able to remember hardly any of the names…It can be very embarrassing. But that’s just one example. There are plenty of other situations where I realize I’m going to go there with some trepidation.”

Bob described a range of coping strategies. He uses his computer and smart phone to aid his memory, and his doctor recommended carrying a note pad for reminders—but this strategy frustrates him and slows him down (Image 2). Bob enjoys biking for leisure, but he worries about safety and hopes that he will have the capacity to recognize when it becomes unsafe for him to continue biking. Bob also enjoys reading non-fiction and best-selling novels, even though he has to write the names of characters at the bottom of pages in order to remember them. He mentions having mixed feelings about his need to re-read books and his difficulty keeping track of stories.

Like the other “Typical Day” participants, Bob emphasized aspects of his life that remain rewarding and largely unaffected by MCI. He offered examples like spending time with his grandchildren, drawing, and painting. He also described how much he misses having a dog, which he believes would have been therapeutic during particularly difficult times.

MCI is a fact of life for millions of Americans and their families. The trials of cognitive decline, and the challenges of slowly losing a connection to a loved one, can be frustrating and at times overwhelming. But as one family member emphasized, “you take every day and live it and love it and go on from there.”