Cerebrovascular support is critical for healthy cognitive aging. Reduced cerebral blood flow in aging is caused, among others, by hypertension, arteriosclerosis (i.e., arterial stiffness) and plaque formation. Arterial stiffness is predictive of cognitive decline, is a critical risk factor for cerebrovascular accidents, and has been linked to the accumulation of beta-amyloid in Alzheimer’s disease. The elasticity of cerebral arteries is influenced by lifestyle factors, including cardiorespiratory fitness (CRF). We will discuss data obtained in our laboratory with new non-invasive measures of cerebrovascular health (pulse-DOT, a diffuse optical tomographic method for studying cerebral arteriosclerosis), in conjunction with anatomical, functional, and cognitive assessments. These findings support a model in which localized changes in arteriosclerosis lead to specific profiles of structural, functional, and cognitive declines, paving a way to individualized interventions.