While dementia is generally associated with people over the age of 65, a shocking number of people develop it in their middle-ages or younger. A new study has determined more than a dozen lifestyle factors that increase a person’s risk of developing the disease early.

Published Tuesday in JAMA Neurology, the study identified 15 lifestyle factors that could put someone at an increased risk of developing the condition. These include everything from alcohol abuse, to lower educational attainment, mental health issues and genetic variation.

For the study, British researchers gathered data from the UK Biobank, a massive database of health and lifestyle information on 355,567 Britons dating back to 2006. Among them, 485 people were diagnosed with early onset dementia — when the disease is diagnosed before age 65. Using the survey information, they analyzed how different lifestyle factors were linked to these cases.

“This is the largest and most robust study of its kind ever conducted. Excitingly, for the first time it reveals that we may be able to take action to reduce risk of this debilitating condition, through targeting a range of different factors,” David Llewellyn, M.D., a professor at the University of Exeter who did not take part in the research, said in a statement.

In total, researchers analyzed 39 factors, gauging each by how likely they were to appear in a person who developed early onset dementia when compared to someone else.

“This breakthrough study illustrates the crucial role of international collaboration and big data in advancing our understanding of dementia. There’s still much to learn in our ongoing mission to prevent, identify, and treat dementia in all its forms in a more targeted way,” Dr. Llewellyn continued.

It should be noted, however, that early-onset dementia is a relatively rare condition, and the population of people experiencing the condition in this study is low.

They found that people who were not formally educated, effectively not having received a college degree, were 66% more likely to develop the condition than their more-educated peers. 

Alcohol use disorder also significantly increased early-onset dementia rates (391% increased risk) compared to peers. Other factors included being a current smoker (73%), being socially isolated (26%), married (38%), living in an area with high particulate matter exposure (25%) and having severely low vitamin D levels (66%).

“We’re witnessing a transformation in understanding of dementia risk and, potentially, how to reduce it on both an individual and societal level,” Leah Mursaleen, who leads research at Alzheimer’s Research UK and did not take part in the study, said in a statement. “In recent years, there’s been a growing consensus that dementia is linked to 12 specific modifiable risk factors such as smoking, blood pressure and hearing loss. It’s now accepted that up to four in 10 dementia cases worldwide are linked to these factors.”

Some medical diagnoses can also increase early onset dementia risk. These include experiencing a stroke (326%), high blood pressure (44%), diabetes (127%), dangerously low blood sugar (631%) and heart disease (177%). These issues are also linked to the development of dementia at a more typical age.