Screening tools are created and administered within specific political, cultural and clinical contexts that problematize their supposed universality. This paper, drawing on interviews and participant observation undertaken in 2008 in New Delhi in India, examines how clinical environments influence the interpretations and use of the Mini Mental State Examination (MMSE), a popular screening instrument for dementia. Findings indicate that while doctors recognize the limitations of the MMSE in theory, its continued use in practice is because of time shortages and competing work demands. Yet misdiagnosis or even false-positive screening has implications for service delivery and quality of care. Further research is necessary into how diagnoses are made, which account for cultural and structural variance.