Cognitive assessment in Spanish — delirium, orientation, dementia

Cognitive assessment in Spanish: orientation questions, CAM delirium screening, attention and memory testing, explaining confusion to patients and families, delirium versus dementia distinction, and family reorientation coaching — phrase by phrase.

Cognitive assessment of a Spanish-speaking patient requires more than a translation of the MMSE or the CAM — it requires culturally adapted orientation questions, an understanding of how education level affects baseline performance, and the ability to explain what is happening to a frightened family who may attribute confusion to spiritual causes, medication side effects, or something the hospital did wrong. This page gives you the specific phrases for cognitive assessment in Spanish — orientation questions for person, place, and time; CAM delirium screening; attention and memory testing; explaining cognitive changes to patients and families; delirium versus dementia distinction; and family coaching for reorientation — phrase by phrase.

Orientation assessment — person, place, time, and situation

Before asking orientation questions, establish rapport and explain what you are doing. A patient who feels tested rather than cared for will be defensive, which affects performance. Frame the assessment as a routine check.

• Voy a hacerle unas preguntas de rutina — las hacemos con todos los pacientes para asegurarnos de que está bien. No son un examen — solo nos ayudan a ver cómo está el cerebro bajo el estrés de la enfermedad. — I am going to ask you some routine questions — we do these with all patients to make sure you are doing well. It is not an exam — it just helps us see how the brain is doing under the stress of illness.
• Person: ¿Me puede decir su nombre completo? — Can you tell me your full name?
• Place: ¿Sabe dónde está usted ahora mismo? ¿En qué ciudad? ¿En qué edificio o lugar? — Do you know where you are right now? What city? What building or place?
• Time — day and date: ¿Sabe qué día de la semana es hoy? ¿Y en qué mes estamos? ¿En qué año? — Do you know what day of the week it is today? And what month are we in? What year?
• Situation: ¿Recuerda por qué está aquí — qué pasó que lo trajo al hospital? — Do you remember why you are here — what happened that brought you to the hospital?
• If the patient cannot answer: No hay problema — eso nos ayuda a saber cómo ayudarle mejor. ¿Hay algo que no recuerda bien? — That is fine — that helps us know how to help you better. Is there something you cannot remember well?
• Note on education: Some patients from rural Latin American backgrounds may not know the exact date even at baseline — hospitalization worsens this. Always ask the family what is baseline for this patient before interpreting the score.

Attention assessment — digit span and vigilance

• Voy a decirle unos números y quiero que los repita exactamente como los digo — en el mismo orden. — I am going to say some numbers and I want you to repeat them exactly as I say them — in the same order. (Forward digit span — start with 3 digits, advance to 5–7.)
• Ahora voy a decirle unos números y quiero que los repita en orden inverso — del último al primero. Por ejemplo, si digo 1-2-3, usted dice 3-2-1. — Now I am going to say some numbers and I want you to repeat them in reverse order — last to first. For example, if I say 1-2-3, you say 3-2-1. (Backward digit span — start with 3 digits; inability to do 3 is significant.)
• Voy a decir unas letras. Cada vez que escuche la letra "A", golpee la mesa con la mano — una vez. Si es cualquier otra letra, no haga nada. — I am going to say some letters. Every time you hear the letter "A," hit the table with your hand — once. If it is any other letter, do not do anything. (Vigilance test — read: A-B-A-A-C-A-D-A-A-B at 1 letter/second. More than 2 errors is significant.)
• Cuente hacia atrás desde el 100, de siete en siete — 100, 93, 86... — Count backwards from 100, subtracting 7 each time — 100, 93, 86... (Serial sevens — note that many patients with less than primary school education cannot do this at baseline.)

CAM delirium screening — the four features

The Confusion Assessment Method (CAM) is positive when features 1 and 2 are present, plus either feature 3 or 4. The family's report of baseline is essential for feature 1.

• Feature 1 — acute onset and fluctuating course (ask the family): ¿Nota usted que su familiar está diferente de cómo es normalmente — más confundido/a, más inquieto/a, o menos alerta que en casa? ¿Y cambia durante el día — hay momentos en que está más claro/a y momentos en que está más confundido/a? — Do you notice that your family member is different from how they normally are — more confused, more restless, or less alert than at home? And does it change during the day — are there moments when they are clearer and moments when they are more confused?
• Feature 2 — inattention: Administer digit span or letter vigilance test in Spanish as described above. Score: inability to repeat 3 digits forward or 2 digits backward indicates significant inattention.
• Feature 3 — disorganized thinking: ¿Puede un elefante nadar? ¿Puede una piedra flotar en el agua? ¿Tiene usted dos manos? ¿Hay peces en el mar? — Can an elephant swim? Can a rock float in water? Do you have two hands? Are there fish in the sea? Assess for yes/no consistency and observe for tangential, incoherent, or rambling responses.
• Feature 4 — altered level of consciousness: Observe and document: Alert (normal), Vigilant (hyperalert, easily startled), Lethargic (drowsy, easy to arouse), Stuporous (difficult to arouse), Comatose (unarousable).
• CAM positive = features 1 + 2 + (3 or 4).

Explaining confusion and delirium to the family — the brain-under-stress frame

• Lo que su familiar tiene se llama delirium — en español se puede llamar confusión aguda. Es cuando el cerebro reacciona al estrés del cuerpo con confusión temporal. — What your family member has is called delirium — in Spanish it can be called acute confusion. It is when the brain reacts to the stress of the body with temporary confusion.
• El delirium puede ser causado por una infección, una cirugía, los medicamentos, el dolor, el no dormir, o la deshidratación — o una combinación de varios. No es una enfermedad permanente del cerebro — es una señal de que el cuerpo está muy estresado. — Delirium can be caused by infection, surgery, medications, pain, lack of sleep, or dehydration — or a combination of several. It is not a permanent brain disease — it is a signal that the body is under great stress.
• La mayoría de las personas se recuperan completamente del delirium cuando encontramos y tratamos la causa. La recuperación puede tardar días o semanas — no siempre desaparece de un día para otro. — Most people recover completely from delirium when we find and treat the cause. Recovery may take days or weeks — it does not always disappear overnight.
• Su familiar puede decir cosas que no tienen sentido, ver o escuchar cosas que no están ahí, o estar muy agitado/a. Eso asusta, pero es parte del delirium — no indica que algo peor está pasando en el cerebro. — Your family member may say things that do not make sense, see or hear things that are not there, or be very agitated. That is frightening, but it is part of delirium — it does not indicate something worse is happening in the brain.

Delirium versus dementia — the key distinction for families

• Hay una diferencia importante entre el delirium — confusión aguda — y la demencia. El delirium aparece de repente, en horas o días, y fluctúa durante el día — hay momentos mejores. La demencia aparece muy lentamente, en meses o años, y es más estable día a día. — There is an important difference between delirium — acute confusion — and dementia. Delirium appears suddenly, in hours or days, and fluctuates during the day — there are better moments. Dementia appears very slowly, over months or years, and is more stable day to day.
• Una persona que ya tenía demencia puede tener delirium encima de la demencia — a eso se le llama "delirium sobreimpuesto a demencia." El delirium hace que la demencia parezca mucho peor de lo que es en realidad. Si su familiar mejoró antes y ahora está peor de repente — probablemente es delirium, no un avance de la demencia. — A person who already had dementia can have delirium on top of dementia — this is called "delirium superimposed on dementia." Delirium makes the dementia look much worse than it actually is. If your family member improved before and now is suddenly worse — it is probably delirium, not progression of dementia.
• La pregunta clave es siempre: ¿esto es diferente de cómo es su familiar normalmente? Si la respuesta es sí — probablemente hay delirium activo que necesita tratamiento. — The key question is always: is this different from how your family member normally is? If the answer is yes — there is probably active delirium that needs treatment.

Family coaching — reorientation interventions

• Hay cosas concretas que su familia puede hacer para ayudar a que su familiar mejore más rápido del delirium. — There are concrete things your family can do to help your family member recover from delirium faster.
• Oriéntelo al lugar y al tiempo: díganle con calma dónde está, qué día es, qué hora es, y por qué está en el hospital. Repítenlo con paciencia — la persona con delirium necesita muchos recordatorios. — Orient them to place and time: calmly tell them where they are, what day it is, what time it is, and why they are in the hospital. Repeat it patiently — the person with delirium needs many reminders.
• Traigan sus lentes, su audífono, y su dentadura si los usa. La falta de estos hace que la confusión empeore — el cerebro necesita toda la información sensorial que pueda recibir. — Bring their glasses, hearing aid, and dentures if they use them. The absence of these makes confusion worse — the brain needs all the sensory information it can receive.
• Traigan una foto familiar o un objeto conocido de casa — algo que conecte al paciente con su ambiente habitual. Eso reduce la desorientación. — Bring a family photo or a familiar object from home — something that connects the patient to their usual environment. That reduces disorientation.
• Acompáñenlo durante el día — la presencia familiar reduce la agitación y la confusión mucho más que los medicamentos. Por las noches: luces bajas, ambiente tranquilo, mínima estimulación. — Stay with them during the day — family presence reduces agitation and confusion much more than medications. At night: dim lights, quiet environment, minimal stimulation.
• Si su familiar se pone muy agitado/a o intenta quitarse el suero o los tubos — llamen al equipo de enfermería de inmediato. No lo sujeten físicamente solos — eso puede empeorar la agitación. — If your family member becomes very agitated or tries to remove the IV or tubes — call the nursing team immediately. Do not physically restrain them alone — that can worsen the agitation.

FAQs — cognitive assessment in Spanish