My friend recently had dinner with a long-time neighbor who has been diagnosed with mild cognitive impairment.

She told me, “He carried on a good conversation all through dinner. He seemed fine to me.”

She was questioning her neighbor’s diagnosis, since in my friend’s mind, her neighbor appeared normal.

My friend’s reaction is very common and somewhat understandable.

Mild cognitive impairment (MCI) is when changes to the memory or thinking go beyond normal aging but are not severe enough to be called dementia. It’s often an early warning sign that something in the brain is shifting.

People with MCI can still look and sound like themselves in many situations.

In our daily interactions, we tend to judge people based upon their social behavior, conversation, and appearance. My friend’s neighbor could still hold a good conversation, recall familiar facts, and appear normal during that one evening.

Social scripts and long-term memory remain strong for those with MCI. A social script is a well-rehearsed sequence of behaviors or phrases people use in routine social situations - like greeting someone, chatting about the weather, or asking about family.

It is part of what makes social life flow smoothly without requiring much conscious thought.

Think of how automatic this feels:

“Hi! How are you?”

“I’m good! How about you?”

“Good, thanks — it’s been so warm lately!”

No one has to think hard about that exchange – it is scripted by experience and repetition.

People with MCI can often still perform these social scripts flawlessly because they draw on long-term memory and deeply ingrained habits, not the short-term memory or problem-solving areas that are affected early on by their condition.

That is why visitors often walk away thinking “they seemed fine” - because the person is using intact social skills and memory from many years of practice.

It is usually more complex situations, like adhering to medication routines, managing schedules, remembering appointments, or following multi-step tasks that tend to reveal more of the hidden challenges. Those don’t show up during dinner or a visit. 

These individual’s cognitive challenges are real, just not always visible.

Additionally, if a person with MCI is stressed or in an unfamiliar situation they also tend to expose more of their deficits. Having dinner with a neighbor is a relaxing, familiar experience and less likely to create anxiety.

Well-meaning comments like, “They seemed great to me,” can invalidate a family member’s concerns or cause them to question the physician’s diagnosis.

Comments like these can unintentionally lead families to let their loved one take on tasks that are no longer safe or appropriate. For example, allowing someone with mild cognitive impairment to keep managing finances or continue driving could put them - and others - at risk.

It is important to trust family observations; they see the patterns over time.

MCI is often invisible, like many health conditions.

When we take the time to look beyond appearances, we offer something even more valuable than reassurance, we offer understanding.