The Mini-Mental State Questionnaire (MMSQ) has been established as a reliable research instrument and is recommended for the early detection of impaired mental status (Fainsinger et al, 1993). Using reflection on a clinical incident, the problems associated with the clinical application of the MMSQ that may outweigh its usefulness are identified. The patient's experience of MMSQ as routine cognitive monitoring can be distressing as the person experiences loss of cognitive ability in a visible way. This experience has a negative influence on the person's quality of life, which is contrary to the essential aim of palliative care. Research evidence suggests that the MMSQ lacks specificity (the ability to detect impaired mental status) because it is affected by pre-morbid ability and intelligence, and therefore cannot be used to assess competence in decision making. Further research on the meaning of losing cognitive ability in terminal illness and other cognitive assessment strategies is required.