Toledo Study for Healthy Aging in Middle Age: Frailty and Early Vascular Decline at the Onset of the Pathogenic Chain of Disability

This special section of The Journals of Gerontology Series A, dedicated to the inherent biological aging processes in human beings, aims to introduce the Toledo Study for Healthy Aging in middle age (TSHAma). This editorial section briefly presents an article disclosing the novel methodology employed in the TSHAma, and 2 research articles regarding cerebral hemodynamics during exercise and its relationship with associated variables at the onset of the pathogenic chain to disability among the middle-aged population. Dementia and frailty, acknowledged as major risk factors for disability, might be preceded by vascular disease (1,2). The early detection and management of frailty and vascular decline is emerging as one of the most cost-effective tools to fight against disability and one of the most important public health resources to delay the onset of cognitive impairment and dementia in older adults. During mid-life, systemic vascular dysfunction becomes increasingly evident and both functional and structural cerebrovascular repercussions begin to be noticeable as well (3). Lifestyle is also recognized as a contributing factor influencing the age of onset of vascular decline. There is a large body of scientific evidence supporting the idea that obesity and sedentary behaviors might serve as precursors of early vascular decline, whereas engagement in physical activity may delay the appearance of the vascular aging process (4,5). Therefore, in the pursuit of a life-cycle perspective, the TSHA, a unique cohort designed for the comprehensive study of frailty from a multidimensional standpoint among older people (6), has also included a group of middle-aged subjects, ranging from 50 to 55 years old (TSHAma).