Abstract
INTRODUCTION: Education can protect against cognitive decline and dementia through cognitive reserve and reduced vascular risk. This study examined whether vascular risk mediates the relationship between education and white matter hyperintensity (WMH) burden. METHODS: Data from 1089 older adults from the National Alzheimer's Coordinating Center were analyzed. A composite vascular score was created using diabetes, hypertension, hypercholesterolemia, smoking, alcohol abuse, body mass index, and blood pressure. Linear regressions and mediation analyses examined associations and indirect effects between education, vascular risk, and WMH, adjusting for age, sex, and diagnosis. RESULTS: Higher education was associated with lower vascular risk (p < .001) and WMH burden (p = .01). Mediation analysis showed an indirect effect of education on WMH via vascular risk (a*b = -0.02, p = .004), accounting for 23% of the total effect. DISCUSSION: Education influences cerebrovascular health via reducing vascular risk. Addressing vascular health may reduce WMH burden.