AbstractBackgroundPersons with mild cognitive impairment (PwMCI) experience a slight but noticeable decline in everyday functioning. Although more attention is directed to the cognitive manifestation in this preclinical stage, little is known about the co‐existing neuropsychiatric symptoms (NPS). This study aimed at examining the symptom experience of PwMCI, with a particular focus on how neuropsychiatric symptoms manifested in the complex dynamic between the personality, coping, and social support profiles of the PwMCI.MethodA mixed‐method study was conducted from March to October 2020 in two community centers in Hong Kong. A convenience sample of 152 PwMCI (response rate: 75.6%) responded on the Chinese version of Memory Inventory in Chinese, Montreal Cognitive Assessment, Mild behavioral impairment ‐ Checklist, Multidimensional Scale of Perceived Social Support, Simplified Coping Style Questionnaire, and NEO‐Five Factor Inventory. A purposive subsample of 30 participants was invited to have in‐depth interviews on how they lived with the symptom experience associated with MCI.ResultThe mean age of the overall sample was 75.1 (SD=5.90), with a majority (87.5%) were female. They were characterized by their cognitive deficits such as impaired attention and memory and intense emotional responses, including depression, anxiety, agitation, and lack of motivation. Surprisingly, the cognitive deficit was not associated with NPS. Instead, by using hierarchical regression analysis, more severe NPS was associated with neuroticism (β=0.333, p<.001), subjective memory complaints (β=0.617, p<.001), perceived lower social supports (β= ‐0.071, p=.049), and negative coping (β=0.384, p=.027). As for their lived experience, the content analysis identified four themes: 1) symptom manifestations, 2) coping strategies, 3) anticipated losses, and 4) negative outlooks on future orientation. Living with MCI was a highly challenging experience and was characterized by distressing cognitive and psychological symptoms, role and social dysfunction, and fear of losing functional independence and self‐identity. In facing the progressive deteriorating disease trajectory of dementia, the informants reported strong feelings of uncertainty, powerlessness, and helplessness.ConclusionPwMCI were highly aware of their cognitive manifestations and concomitant functional deterioration, together with maladaptive coping, triggered a cluster of negative emotional responses. Future interventions should safeguard their functional independence, optimize their coping, and strengthen their self‐identity.