Routine Cognitive Screening in Primary Care: A Practical, Puerto Rico–Focused Approach

By Dr. Rolance G. Chavier Roper, MD Vice President of Medical Affairs Epic Healthcare Solutions

The Puerto Rico population is aging rapidly. More than a quarter of the population is now over 60, and the proportion of adults 65 and older has climbed sharply in recent years. Alzheimer's disease and related dementias rank among the top causes of illness and death on the island, especially for older adults. 

Primary care physicians manage these patients daily— many with diabetes, hypertension, kidney disease, depression, sleep problems, or multiple medications— all of which quietly raise the risk of cognitive decline.

The Challenge: Moving from Reactive to Proactive Care

Too often, cognitive issues surface only when obvious: family complaints, medication errors, falls, ER visits, or loss of independence. Mild Cognitive Impairment (MCI), the earlier stage where people remain mostly independent, is frequently overlooked or undocumented. Yet this is precisely when interventions can make the biggest difference, controlling risk factors, optimizing medications, slowing decline, and helping families prepare. Once full dementia appears, care becomes reactive rather than focused on early detection and timely intervention.

Overcoming the Barriers of Daily Practice

Primary care doctors have valid reasons to question the routine use of cognitive screening. Visits are short, resources are limited, and traditional solutions often depend too much on education or cultural factors. However, as you know, cognitive screening is a requirement for the Annual Wellness Visit.

When screening adds burden without real benefit, it’s fair to hesitate. The solution lies in objective, practical solutions that fit busy primary care settings without upending daily workflows.

To bridge the gap between clinical necessity and operational reality, the eCAMP (Early Cognitive Assessment Program) can help by allowing physicians to perform quick (around 5 minutes) objective cognitive screenings that deliver standardized results.

eCAMP automates the cognitive assessment required for the Annual Wellness Visit, allowing the medical office to fulfill the task efficiently.

• Rely minimally on language or education: Designed to work well for the island’s patient population.

• Risk Stratification: They don’t just screen for cognitive impairment; they act as a risk-stratification aid—much like an HbA1c guides diabetes care—helping answer: Which patients need closer cognitive attention now?

• Operational Efficiency: By automating the cognitive assessment process, the eCAMP program absorbs complexity instead of creating it, keeping care manageable without lengthening visits or increasing administrative load.

A Structured Pathway for Success

An abnormal result should never leave the physician hanging. When eCAMP flags a concern, the patient enters a defined care track, emphasizing:

• Better control of vascular and metabolic risks.

• Medication review (especially reducing anticholinergic burden).

• Education on lifestyle steps for brain health.

• Ongoing monitoring where the primary care doctor remains the lead.

Smarter Primary Care

The request is modest: screen routinely for patients 65 and older, or those 60+ with high-risk conditions, via a practical, automated process. This approach aligns with Puerto Rico’s realities: limited access to specialty care and long waits for neurological care.

By incorporating the eCAMP program, medical practices benefit from more thorough wellness visits, stronger documentation, and alignment with brain health goals, all while delivering smarter primary care to a population that urgently needs it.