{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T23:04:59Z","timestamp":1768518299360,"version":"3.49.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T00:00:00Z","timestamp":1659657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HR21C0885"],"award-info":[{"award-number":["HR21C0885"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HU20C0111"],"award-info":[{"award-number":["HU20C0111"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018688","name":"Korea Disease Control and Prevention Agency","doi-asserted-by":"publisher","award":["2021-ER1006-00"],"award-info":[{"award-number":["2021-ER1006-00"]}],"id":[{"id":"10.13039\/100018688","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2020R1A2C1009778"],"award-info":[{"award-number":["NRF-2020R1A2C1009778"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Many epidemiological studies suggest that lower education levels and vascular risk factors increase the likelihood of developing Alzheimer's disease dementia (ADD) and subcortical vascular dementia (SVaD). However, whether the brain-battering hypothesis can explain the relationship between education levels and the clinical diagnosis of dementia remains controversial. The objective of this study was to investigate whether vascular risk factors mediate the association between education level and the diagnosis of amyloid-beta positive (A\u03b2+) ADD and amyloid-beta negative (A\u03b2-) SVaD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 376 participants with A\u03b2 normal cognition (A\u03b2- NC), 481 with A\u03b2+ ADD, and 102 with A\u03b2- SVaD. To investigate the association of education level and vascular risk factors with these diagnoses, multivariable logistic regression analysis was used, with age, sex, and <jats:italic>APOE<\/jats:italic> \u03b54 carrier status used as covariates. Path analysis was performed to investigate the mediation effects of hypertension on the diagnosis of A\u03b2- SVaD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The A\u03b2- SVaD group (7.9 \u00b1 5.1 years) had lower education levels than did the A\u03b2- NC (11.8 \u00b1 4.8 years) and A\u03b2+ ADD (11.2 \u00b1 4.9 years) groups. The frequencies of hypertension and diabetes mellitus were higher in the A\u03b2- SVaD group (78.4 and 32.4%, respectively) than in the A\u03b2- NC (44.4 and 20.8%) and A\u03b2+ ADD (41.8 and 15.8%, respectively) groups. Increased education level was associated with a lower risk of A\u03b2- SVaD [odds ratio (OR) 0.866, 95% confidence interval (CI), 0.824\u20130.911], but not A\u03b2+ ADD (OR 0.971, 95% CI 0.940\u20131.003). The frequency of hypertension was associated with a higher risk of developing A\u03b2- SVaD (OR 3.373, 95% CI, 1.908\u20135.961), but not A\u03b2+ ADD (OR 0.884, 95% CI, 0.653\u20131.196). In the path analysis, the presence of hypertension partially mediated the association between education level and the diagnosis of A\u03b2- SVaD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings revealed that education level might influence the development of A\u03b2- SVaD through the brain-battering hypothesis. Furthermore, our findings suggest that suitable strategies, such as educational attainment and prevention of hypertension, are needed for the prevention of A\u03b2- SVaD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnins.2022.934149","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T06:11:33Z","timestamp":1659679893000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Relationships between educational attainment, hypertension, and amyloid negative subcortical vascular dementia: The brain-battering hypothesis"],"prefix":"10.3389","volume":"16","author":[{"given":"Song","family":"Hwangbo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Ju","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu Hyun","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hee Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duk L.","family":"Na","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyemin","family":"Jang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Won","family":"Seo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1016\/j.jalz.2015.12.006","article-title":"(2016). 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