Science
Dementia May Not Always Be the Threat It Is Now. Here’s Why.
Joan Presky worries about dementia. Her mother lived with Alzheimer’s disease for 14 years, the last seven in a memory-care residence, and her maternal grandfather developed dementia, too.
“I’m 100 percent convinced that this is in my future,” said Ms. Presky, 70, a retired attorney in Thornton, Colo.
Last year, she spent almost a full day with a neuropsychologist, undergoing an extensive evaluation. The results indicated that her short-term memory was fine — which she found “shocking and comforting” — and that she tested average or above in every cognitive category but one.
She’s not reassured. “I saw what Alzheimer’s was like,” she said of her mother’s long decline. “The memory of what she went through is profound for me.”
The prospect of dementia, which encompasses Alzheimer’s disease and a number of other cognitive disorders, so frightens Americans that a recent study projecting steep increases in cases over the next three decades drew enormous public attention.
The researchers’ findings, published in January in Nature Medicine, even showed up as a joke on the Weekend Update segment of “Saturday Night Live.”
“Dementia is a devastating condition, and it’s very much related to the oldest ages,” said Dr. Josef Coresh, director of the Optimal Aging Institute at NYU Langone Health and the senior author of the study. “The globe is getting older.”
Now the findings are being challenged by other dementia researchers who say that while increases are coming, they will be far smaller than Dr. Coresh and his co-authors predicted.
Using data from about 15,000 Americans over age 55, collected at four research clinics around the country from 1987 through 2020, Dr. Coresh’s team projected a lifetime dementia risk much higher than previous studies had: 42 percent, though most of that risk didn’t emerge until after age 85.
The higher lifetime number probably reflected the study’s reliance on a more diverse sample than earlier researchers had used, Dr. Coresh said, and more dementia cases identified through in-depth questionnaires, regular phone calls, medical records and death certificates.
The researchers applied their risk calculations to the U.S. population and estimated that the number of people who would develop dementia each year would roughly double, to about a million by 2060, from 514,000 in 2020.
Eric Stallard, an actuary and co-director of the Biodemography of Aging Research Unit at Duke University, read the study and thought the team “seemed very competent at their analysis” of individual risk.
But when it came to the projection that cases would double, which assumed that the incidence of dementia would remain stable over the next 40 years, “I don’t believe it,” Mr. Stallard said.
“The notion that the number of people with dementia will double over the next 25, 30 or 35 years due to the aging of baby boomers is widespread, it’s pervasive — and it’s wrong,” he added.
He and two other Duke researchers recently published a commentary in JAMA pointing out that the age-specific prevalence of dementia in this country had steadily declined for 40 years.
“If your risks are lower than your parents’ risks and this trend continues, you won’t see the doubling or tripling of dementia that’s been projected,” said Dr. Murali Doraiswamy, director of the Neurocognitive Disorders Program at Duke and a co-author of the JAMA article.
To be clear, experts agree that the number of people with dementia will climb in coming decades, simply because the disorder rises so steeply with age and the number of older adults in the United States will increase.
But Mr. Stallard estimates that the increase will be more like 10 to 25 percent by 2050. “It will still be a significant challenge for the health system in the U.S.,” he said.
The Duke group relied on its own long-term study of people over age 65, with more than 21,000 respondents in 1984 and about 16,000 in 2004, plus later data from the national Health and Retirement Study and the National Health and Aging Trends Study.
Their analysis found that among 85- to 89-year-olds, for instance, the proportion with dementia was about 23 percent in the cohort born in 1905. In those born 10 years later, the figure had dropped to about 18 percent.
By the time Americans born in 1935 reached their late 80s, about 11 percent had dementia; the projection for those born from 1945 to 1949 is now about 8 percent.
To Dr. Coresh, whose primary interest was in individual risk, the assumption that past declines would continue at about the current rate “would be great, but is quite an optimistic, dramatic decrease,” he said in an email.
Yet in another longitudinal study of older adults in England and China, published in Nature Aging last year, “we also found these quite marked improvements in more recently born cohorts,” said the lead author, Dr. John Beard, a medical epidemiologist at the Mailman School of Public Health at Columbia University.
“You would expect the increase in the absolute numbers of people with dementia in the U.S. will be less than we feared,” Dr. Beard said.
What has led to the decrease in dementia, also seen in several European countries? Often cited explanations include rising education levels, reduced smoking and improved treatment for high blood pressure and high cholesterol.
The Lancet Commission on dementia, intervention and care has developed a list of 14 modifiable risk factors, including greater use of hearing aids and reduced air pollution, that could still lead to greater declines.
Yet the reverse could also happen. If earlier and more widespread testing increases the number of dementia diagnoses, or if the definition of dementia broadens, rates will increase, Dr. Doraiswamy noted. Increasing life expectancy would have the same effect.
Obesity and diabetes, more common in recent decades, could lead to more dementia, but much-touted new drugs that reduce them could blunt that trend — if people can get them.
“None of this is inevitable,” said Dr. Gill Livingston, a psychiatrist at University College London who leads the Lancet Commission. “It depends on what we do.”
Public health policy makes a major difference, she noted, and, “The U.S. is in a time where policy is changing enormously.”
Dementia rates might rise, for example, “if people have less access to health care, so they are less likely to get their blood pressure treated and their high cholesterol treated,” Dr. Livingston said.
Slashed Medicaid coverage could lead to that result. So could a rollback of environmental policies, “if air pollution increases because of fossil fuels,” she added.
Already, dementia afflicts some American populations far more than others, researchers point out. Older women and Black people face greater risk, along with those who carry the APOE4 gene associated with Alzheimer’s disease.
Health disparities could mean that “affluent people will see lower rates of dementia” because of the new diabetes and obesity drugs, Dr. Doraiswamy said. “People who can’t afford them and whose conditions are not well-managed will see rates go up.”
The debate about how many older adults will develop dementia in coming decades, and about how individuals, families, government and the health care system should respond, will likely continue.
So will Ms. Presky’s fears.
For now, she enrolls in lifelong learning classes, takes walks and yoga classes despite orthopedic problems, listens to podcasts and reads a lot of history and fiction. She and her husband take in theater in New York and Phish concerts on the West Coast and will soon be heading to London and Paris.
Still, her advance directive contains many provisions about dementia. “I remain pessimistic,” she said, noting that her mother was diagnosed at 77. “I have seven more years before I meet her fate.”
Science
Owners of mobile home park destroyed in the Palisades fire say they’re finally clearing the debris
Former residents of the Palisades Bowl Mobile Home Estates, a roughly 170-unit mobile home park completely destroyed in the Palisades fire, received a notice Dec. 23 from park owners saying debris removal would start as early as Jan. 2.
The Bowl is the largest of only a handful of properties in the Palisades still littered with debris nearly a year after the fire. It’s left the Bowl’s former residents, who described the park as a “slice of paradise,” stuck in limbo.
The email notice, which was reviewed by The Times, instructed residents to remove any burnt cars from their lots as quickly as possible, since contractors cannot dispose of vehicles without possessing the title. It followed months of near silence from the owners.
“The day before Christmas Eve … it triggers everybody and throws everybody upside down,” said Jon Brown, who lived in the Bowl for 10 years and now helps lead the fight for the residents’ right to return home. “Am I liable if I can’t get this done right now? Between Christmas and New Year’s? It’s just the most obnoxious, disgusting behavior.”
Brown is not optimistic the owners will follow through. “They’ve said things like this before over the years with a bunch of different things,” he said, “and then they find some reason not to do it.”
Earlier this year, the Federal Emergency Management Agency denied requests from the city and the Bowl’s owners to include the park in the U.S. Army Corps of Engineers cleanup program, which FEMA said was focused on residential lots, not commercial properties. In a letter, FEMA argued it could not trust the owners of the Bowl to preserve the beachfront property as affordable housing.
A tattered flag waves in the wind at Asilomar View Park overlooking the Pacific Palisades Bowl Mobile Estates.
(Myung J. Chun/Los Angeles Times)
The Bowl, which began as a Methodist camp in the 1890s, was purchased by Edward Biggs, a Northern California real estate mogul, in 2005 and split between his first and second wives after his death in 2021. The family has a history of failing to perform routine maintenance and seeking to redevelop the park into a more lucrative resort community.
After FEMA’s rejection, the owners failed to meet the City of L.A.’s debris removal deadlines. In October, the city’s Board of Building and Safety Commissioners declared the park a public nuisance alongside seven other properties, giving the city the authority to complete the debris removal itself and charge the owners the bill.
But the city has yet to find funds to front the work, which is expected to cost millions.
On Dec. 10, City Councilmember Traci Park filed a motion that would order the city to come up with a cost estimate for debris removal and identify funding sources within the city. It would also instruct the city attorney’s office to explore using criminal prosecution to address the uncleared properties.
The Department of Building and Safety did not immediately respond to requests for comment.
Despite the recent movement on debris removal, residents of the Palisades Bowl still have a long road ahead.
On Wednesday, numerous burnt out vehicles still remained at the Pacific Palisades Bowl Mobile Estates. The owners instructed residents they must get them removed as quickly as possible.
(Myung J. Chun/Los Angeles Times)
In mobile home parks, tenants lease their spaces from the landowners but own the homes placed on the land. Before residents can start rebuilding, the Bowl’s owners need to replace or repair the foundations for the homes; fix any damage to the roads, utilities and retaining walls; and rebuild facilities like the community center and pool.
The owners have not responded to multiple requests for comment, but in February, Colby Biggs, Edward Biggs’ grandson, told CalMatters that “If we have to go invest $100 million to rebuild the park and we’re not able to recoup that in some fashion, then it’s not likely we will rebuild the park.”
Mobile home law experts and many residents doubt that the Biggs family would be able to convert the rent-controlled mobile home park into something else under existing law. The most realistic option, should the Biggs decide against rebuilding, would be to sell the park to another owner — or directly to the residents, a course of action the residents have been actively pursuing.
The lack of communication and action from the owners has nonetheless left the Bowl’s eclectic former community of artists, teachers, surfers, first responders and retirees in limbo.
Many are running out of insurance money for temporary housing and remain unsure whether they’ll ever be able to move back.
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By Jamie Leventhal and Alexa Robles-Gil
January 2, 2026
Science
Commentary: ‘Stop exercising, you’re killing yourself.’ Not really, but try more nurture, less torture in 2026
One day my left foot hurt for no good reason. I stood up to shake off the pain and tweaked my right Achilles tendon, so I headed for the medicine cabinet, bent over like an ape because of a stiff back.
Actually, I lied.
It wasn’t one day. It’s pretty much every day.
None of this is severe or serious, and I’m not complaining at the age of 72. I’m just wondering.
Are my exercise routines, which were meant to keep me from falling apart, slowing my demise, or accelerating it?
What better time than the start of a new year to get an answer? In one poll, the top New Year’s resolution for 2026 is exercising more. Also among the top six resolutions are eating healthier, improving physical health and losing weight, so good luck to all you dreamers, and I hope you last longer than I have with similar resolutions.
Instead of a resolution, I have a goal, which is to find a sweet spot — if there is one — between exercise and pain.
Maybe I’m asking too much. I’ve had two partial knee replacements, I’ve got a torn posterior cruciate ligament, a scar tissue knob on a frayed Achilles tendon, a hideously pronated left foot, a right shoulder that feels like it needs an oil change, and a pacemaker that keeps on ticking.
But I decided to get some expert advice that might be useful for anyone who has entered this glorious phase of life in which it’s possible to pull a muscle while taking a nap, or pinch a nerve in your neck while brushing your teeth.
And I knew just whom to call.
Cedars-Sinai orthopedic surgeon Robert Klapper hosts an ESPN radio show called “Weekend Warrior.” This lab-coated Renaissance man, a surfer and sculptor in his spare time, also weighs in regularly on the radio with “Klapper Vision” — clear-eyed takes on all manner of twisted, pulled and broken body parts suffered by elite athletes and banged-up buzzards like me.
On “Weekend Warrior,” Klapper might be talking about knee replacement surgery one minute, segue to Michelangelo’s rendering of the human form, and then insist that a sandwich is not a sandwich without peperoncini. It isn’t necessarily all connected, but it doesn’t matter.
When I emailed Klapper about my aches and pains, he responded immediately to say he’s written one book on hips, another on knees and a third one is in the works with the following title:
“Stop Exercising, You’re Killing Yourself.”
No, he’s not saying you should never get off the sofa. In a phone conversation and later at his office, Klapper said the subtitle is going to be, “Let Me Explain.” He’s making a point about what kind of exercise is harmful and what kind is helpful, particularly for people in my age group.
Dr. Robert Klapper holds up his book about preventing hip surgery.
(Genaro Molina/Los Angeles Times)
My daily routine, I told him, involves a two-mile morning walk with my dog followed by 30 minutes of swimming laps or riding a stationary bike.
So far, so good.
But I also play pickleball twice a week.
“Listen, I make a living from pickleball now,” Klapper said. “Exercise is wonderful, but it comes in two flavors.”
One is nurturing, which he calls “agercise” for my demographic.
The other is abusive, and one of Klapper’s examples is pickleball. With all its starts and stops, twists and turns, reaches and lunges, pickleball is busting the Medicare bank, with a few hundred million dollars’ worth of injuries each year.
I know. The game looks pretty low key, although it was recently banned in Carmel-by-the-Sea because of all the racket. I had no idea, when I first picked up a paddle, that there’d be so much ice and ibuprofen involved, not to mention the killer stares from retirees itching for a chance to drill you in the sternum with a hot laser.
“This is a sport which has the adrenaline rushing in every 50-year-old, 60-year-old, 80-year-old,” Klapper told me in his office, which is the starting point in his joint replacement factory. The walls are covered with photos of star athletes and A-list Hollywood celebrities he’s operated on.
“I see these patients, but they’re not coming to me with acute injuries. They didn’t snap their Achilles tendon … like they do in tennis. They’re not snapping their ACL like they are in pickup basketball,” Klapper said. “They’re coming to me saying, ‘My shoulder is killing me, my knee is killing me.’ ”
Pickleball has obvious conditioning benefits for every age group. But it can also worsen arthritis and accelerate joint degeneration, Klapper said, particularly for addicts who play several times a week.
Not that he’s the first MD to suggest that as you age, walking, cycling and swimming are easier on your body than higher-impact activities. As one doctor said in an AARP article on joint care and the benefits of healthy eating, watching your weight and staying active, “the worst thing you can do with osteoarthritis after 50 is be sedentary.”
Still, I thought Klapper might tell me to stop pickling, but he didn’t.
“Pickleball is more than a sport to you … and all of your compadres,” he said. “It’s mental. You need it because of the stress. The world’s falling apart.… I want you to play it, but I want you to do the nurturing exercises so you can do the abuse.”
There’s no fountain of youth, Klapper said, but the closest thing is a swimming pool.
OK, but I already swim three times a week.
Dr. Robert Klapper meets with patient Kathleen Clark, who is recovering from knee surgery.
(Genaro Molina/Los Angeles Times)
Klapper had different ideas.
“You need to be walking forward and backwards for half an hour,” he said. Do that three times a week, he told me, and ride a stationary bike three times.
Why the water walking?
“We as humans take over a million steps a year. Forget pickleball, just in … daily living,” Klapper said, so I’m well beyond 72 million steps.
“Think about that,” he said.
Do I have to?
Water walking will develop muscles and joints without the stress of my full weight, and that could “optimize” my pickleball durability and general fitness, Klapper said. Buoyancy and the touch of water on skin are magic, he said, but there’s science involved too.
“It’s hard to move your arms and legs and your body through water, and yet it’s unloading the joint,” Klapper said. “And finally — and this is the real X factor — when you close your eyes and straighten your elbow and bend your elbow, straighten your knee and bend your knee … your brain knows where your limbs are in space.”
This is called proprioception, Klapper said. Receptors in your skin, muscles, ligaments and tendons send messages to your brain, leading to better balance, coordination and agility and potentially reducing risk of injury.
There are lots of exercises for sharpening proprioception, but the surfing doctor is partial to bodies of water. At my age, he said, my proprioception “batteries are running low,” but I can recharge them with a short break from pickleball and a focus on the pool.
“You can’t guarantee anything in life and medicine,” Klapper said. “But I guarantee you, a month into it, you’re going to feel so much better than you do at this moment.”
It’s worth a try, and I’ll let you know how it goes.
In the pool and on the court.
steve.lopez@latimes.com
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