The possibility of becoming severely cognitively impaired is among the most consequential risks facing older adults and their families. In addition to the emotional and physical toll, the financial consequences can be overwhelming, as many patients require expensive paid care. This study uses the Dynamic Simulation of Income Model (DYNASIM) to project the risk and costs of severe cognitive impairment at older ages over the coming decades. Our projections show that the chances of ever becoming impaired vary widely by education, race and Hispanic origin, and sex. Cost and care burdens can be significant for families. Those lower in the income distribution who become impaired can expect to deplete most or all of their wealth.