Experience of living with mild cognitive impairment: A meta-synthesis and conceptual integration of dynamic cognitive, psychological, and social dimensions

Background: Mild cognitive impairment is a transitional stage between normal aging and dementia, marked by cognitive decline alongside emotional distress and disruption in self-identity and social roles. Unlike those with advanced dementia, individuals with mild cognitive impairment often retain insight into their condition, leading to a complex interplay of uncertainty, stigma, and fluctuating symptoms. While neurobiological research has advanced understanding of structural and functional changes in mild cognitive impairment, it offers limited insight into how individuals psychologically and socially adjust to these changes in everyday life. This gap hindered the development of a conceptual model that reflects the dynamic, context-sensitive nature of coping, emotional regulation, and cultural meaning-making that are central to psychosocial adaptation. Therefore, we conducted a meta-synthesis of qualitative studies to develop a novel conceptual framework that integrates these psychosocial dimensions. Objective: To synthesize qualitative research on the lived experiences of individuals with mild cognitive impairment and to develop a conceptual framework that captures their dynamic, context-sensitive nature of coping. Design: Meta-synthesis of qualitative studies. Participants: 469 individuals (mean age = 74.94) with mild cognitive impairment. Methods: A systematic literature search across six databases identified 20 eligible qualitative studies. Thematic analysis synthesized first- and second-order interpretations into third-order constructs, generating overarching insights. Results: Three overarching themes emerged: (1) Living with mild cognitive impairment: cognitive decline disrupted daily routines, social roles, and self-perception, often triggering fear, grief, and frustration tied to a mismatch between expected and actual abilities; (2) Coping as a dynamic and contextual process: coping as a fluid and context-dependent process shaped by shifting personal goals, emotional states, and social environments; and (3) Making sense of mild cognitive impairment: individuals and families sought to interpret the diagnosis and understand its implications. Cultural norms, stigma, and access to information influenced how people perceived their condition and adjusted to uncertainty. Conclusions: Integrating our findings with stress-coping theory and the psychological flexibility framework, we developed the Dynamic Stress-Response for Cognitive Decline Model, which captures how the perceived mismatch between expected and actual cognitive performance drives distress and the coping process. Psychological flexibility supports our understanding of the psychological processes underlying both adaptive and maladaptive coping responses, as well as the impact of contextual factors such as family support and cultural expectations. This conceptual integration extends beyond static coping models by emphasizing fluidity, identity, and culture, thereby providing a foundation for person-centered interventions that support adaptive coping in individuals with mild cognitive impairment. Registration: PROSPERO (CRD42023471772).