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Dementia: forms, symptoms, treatment

by Josephine Andrews
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Dementia is a persistent or progressive impairment of memory, thinking or other brain functions. The reason for this can be different. There are different forms of dementia such as Alzheimer’s disease and vascular dementia. Read more about the topic here: What is dementia (definition)? What forms are there? How do you recognize dementia? How is it diagnosed and treated?

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

F03 F02 F01 G31 F00 G30

quick overview

  • Important forms of dementia: Alzheimer’s disease (45-70% of all dementia), vascular dementia (15-25%), Lewy body dementia (3-10%), frontotemporal dementia (3-18%), mixed forms (5- 20%)
  • Symptoms: In all forms of dementia, mental performance is lost in the long term. Other symptoms and the exact course vary depending on the type of dementia.
  • Affected: Mainly people over 65 years of age. Exception: frontotemporal dementia, which begins around the age of 50. Most dementia patients are women because, on average, they live longer than men.
  • Causes: Primary dementia (such as Alzheimer’s ) are independent diseases in which nerve cells in the brain gradually die off – the exact reason for this is unknown. Secondary dementia is the result of other diseases (such as alcohol addiction, metabolic disorders, inflammation) or medication.
  • Treatment: Drugs, non-drug measures (such as occupational therapy , behavioral therapy, music therapy , etc.)
  • Is dementia curable? Primary dementia cannot be cured. However, the right treatment can delay the course. Secondary dementia can sometimes be cured if the cause is identified and treated early.

What is dementia?

The term dementia does not refer to a specific disease, but to the joint occurrence of specific symptoms (= syndrome), which can have a wide variety of causes. Overall, the term includes more than 50 forms of disease (such as Alzheimer’s disease and vascular dementia).

All forms of dementia have in common the persistent or progressive impairment of memory, thinking and/or other brain functions . Other symptoms (eg in interpersonal behavior) are often added.

Primary and secondary dementia

Under the term ” primary dementia” includes all forms of dementia that are independent clinical pictures. They originate in the brain, where more and more nerve cells die off.

The most common primary dementia (and generally the most common dementia-related illness) is Alzheimer’s disease. Vascular dementia follows in second place. Other primary forms of dementia are frontotemporal and Lewy body dementia.

As ” secondary dementia” refers to dementia diseases that are caused by medication or other diseases such as alcohol addiction, thyroid diseases or pronounced vitamin deficiencies. Secondary forms of dementia are rather rare – they account for about ten percent of all cases of dementia.

There are also mixed forms of dementia disease processes, in particular mixed forms of Alzheimer’s disease and vascular dementia.

Pseudodementia is not “real” dementia and is therefore neither a primary nor a secondary form of dementia. It is a symptom – usually of major depression.

Cortical and subcortical dementia

Another classification of the symptoms is based on where the changes occur in the brain: cortical dementia is accompanied by changes in the cerebral cortex (Latin: cortex cerebri). This is the case, for example, with Alzheimer’s disease and frontotemporal dementia.

Subcortical dementia , on the other hand, is the term used to describe dementia diseases with changes below the cerebral cortex or in the deeper layers of the brain. This includes subcortical arteriosclerotic encephalopathy (SAE), a form of vascular dementia.

However, this classification is not unproblematic because there are numerous mixed and transitional forms. For example, dementia with Lewy bodies can manifest either as a cortical or as a mixed form.

dementia syndromes

The term dementia syndrome is often equated with “dementia”. It is understood as a general intellectual deterioration, for example memory and orientation disorders as well as speech disorders. The personality of the patient often changes over time.

Pseudodementia must be distinguished from dementia syndrome. This term includes temporary brain disorders that are feigned by an inhibition of thinking and drive. Pseudodementia is most common in the context of severe depression. If the depression is treated properly, the symptoms of pseudodementia usually subside.

You can find out more about dementia syndrome and pseudodementia in the article  Dementia Syndrome .

senile dementia and senile dementia

Because older people in particular suffer from dementia, one often speaks of senile dementia. However, this term should not be equated with “senile dementia”: The latter refers to “senile dementia of the Alzheimer’s type” (SDAT) – a manifestation of Alzheimer’s disease in old age. This is in contrast to presenile Alzheimer’s disease, which usually occurs in the fifth or sixth decade of life.

Today, presenile and senile dementia of the Alzheimer’s type are mostly collectively referred to as Alzheimer’s disease or dementia of the Alzheimer’s type (DAT).

Dementia: Symptoms

With dementia, mental performance is lost in the long term. In detail, the symptoms of dementia depend on which disease is involved – for example Alzheimer’s or vascular dementia.

Alzheimer’s disease

The onset of dementia symptoms in Alzheimer’s (and many other forms of dementia) are problems with short-term memory: those affected become increasingly forgetful, often misplace things and have difficulty concentrating. Sometimes they suddenly can’t think of common terms in a conversation. Orientation problems in unfamiliar surroundings are also the first signs of dementia of the Alzheimer’s type.

Advanced dementia symptoms in Alzheimer’s patients affect long-term memory. Patients are increasingly unable to remember the past. At some point they can no longer recognize people who are close to them. In late stages of dementia, patients also lose physical strength and need help with all activities.

The brain shrinks in Alzheimer’s
In Alzheimer’s disease, nerve cells die. This causes the brain to slowly shrink.

You can read more about the symptoms, causes, diagnosis and treatment of this most common form of dementia in the article Alzheimer’s disease .

vascular dementia

Vascular dementia is the result of circulatory disorders in the brain. Symptoms of dementia are often similar to those of Alzheimer’s. However, the exact clinical picture of vascular dementia depends on where in the patient’s brain the circulatory disorders occur and how severe they are.

Possible symptoms include problems with attentive listening, coherent speech and orientation. These dementia signs also exist in Alzheimer’s, but they often appear earlier and more severely in vascular dementia. In addition, memory can be preserved longer in vascular dementia.

Other possible signs of vascular dementia are, for example, gait disturbances, slowing down, bladder emptying disorders, concentration disorders, personality changes and psychiatric symptoms such as depression.

You can read more about the symptoms, causes, diagnosis and treatment of this second most common form of dementia in the article on vascular dementia .

Lewy body dementia

Lewy body dementia also manifests itself with dementia symptoms similar to those of Alzheimer’s disease. However, many patients show hallucinations (sensory illusions) in the early stages of the disease. On the other hand, the memory usually lasts longer than in Alzheimer’s.

In addition, many people with Lewy body dementia show symptoms of Parkinson’s disease . These include stiff movements, involuntary tremors and an unstable posture. Therefore, those affected often sway and fall.

Another special feature of this form of dementia is that the physical and mental condition of the patient sometimes fluctuates greatly. At times those affected are entering and wide awake, at other times confused, disoriented and withdrawn.

You can read more about the symptoms, causes, diagnosis and treatment of this form of dementia in the article Lewy body dementia .

Frontotemporal dementia

Frontotemporal dementia – also called Pick’s disease or Pick’s disease – shows a completely different course. Typical symptoms of dementia here are changes in personality and often strange behavior: those affected are usually easily irritable, aggressive and behave tactlessly or embarrassingly. Excessive eating and listlessness (apathy) are also possible.

Due to the conspicuous and antisocial behavior of many patients, a mental disorder is often suspected instead of dementia. Typical dementia symptoms such as memory problems only appear in the advanced stage of Pick’s disease. In addition, the language of the patients becomes impoverished.

You can read more about the symptoms, causes, diagnosis and treatment of this rarer form of dementia in the article on frontotemporal dementia .

Difference: Alzheimer’s & dementia of another kind

“What’s the Difference Between Alzheimer’s & Dementia?” Some of those affected and their relatives ask themselves this question, assuming that these are two different clinical pictures. In fact, as mentioned above, Alzheimer’s is just one form of dementia, and by far the most common. The correct question should therefore be what the difference is between Alzheimer’s and other forms of dementia – such as vascular dementia.

A typical difference between these two most common forms of dementia relates to the onset and course of the disease: Alzheimer’s usually begins insidiously and the symptoms slowly worsen. On the other hand, vascular dementia often sets in suddenly and the symptoms gradually increase.

So much for theory – but practice often looks a little different. Each dementia can progress differently from patient to patient, which makes it difficult to distinguish between the different forms of the disease. There are also mixed forms, such as Alzheimer’s and vascular dementia. Those affected show characteristics of both forms of dementia, which is why a diagnosis is often difficult.

You can read more about similarities and differences in important forms of dementia in the article Difference between Alzheimer’s and dementia?

Dementia: causes and risk factors

In most cases of dementia, it is a primary disease (primary dementia), ie an independent disease that originates in the brain: in those affected, nerve cells gradually die off and the connections between the nerve cells are lost. Doctors speak of neurodegenerative changes here. Its exact cause varies depending on the form of primary dementia and is often not fully understood.

Alzheimer’s dementia: causes

In the most common form of dementia, plaques form in the brain. These are deposits of a diseased protein (beta-amyloid). Doctors suspect that these plaques contribute to the cause of Alzheimer’s disease or at least promote it.

It is not known exactly why the plaques form. Rarely – in about one percent of cases – the causes are of a genetic nature: changes in the genetic material (mutations) lead to plaque formation and the outbreak of the disease. Such mutations make Alzheimer’s hereditary dementia. In the vast majority of cases, however, one does not know exactly why someone has Alzheimer’s disease.

Vascular dementia: causes

In vascular (vascular) dementia, circulatory disorders in the brain lead to the death of nerve cells. For example, they can be the result of several small strokes (due to vascular occlusion) that occur simultaneously or at different times in one region of the brain (“multi-infarct dementia”). Sometimes vascular dementia also develops on the basis of a larger cerebral hemorrhage , for example in patients with high blood pressure.

Rarer causes of vascular dementia include vascular inflammation and genetic diseases.

Lewy body dementia: causes

In Lewy body dementia, protein residues of the transport protein alpha-synuclein, which among other things regulate the release of dopamine, are deposited in the nerve cells of the cerebral cortex. These so-called Lewy bodies impede communication between nerve cells. Why they form is mostly unknown. The disease is very rarely genetic.

Frontotemporal dementia: causes

In frontotemporal dementia, nerve cells in the frontal and temporal lobes of the cerebrum gradually die off. Again, the cause is largely unknown. Some of the cases are genetic.

Secondary dementia: causes

The rare secondary dementia are caused by other illnesses or medications. They can be triggered, for example, by alcohol addiction, thyroid disorders, liver diseases, infections (e.g. HIV encephalitis, neuroborreliosis ) or a vitamin deficiency. Drugs are also possible causes of dementia.

risk factors for dementia

Older age and a corresponding genetic predisposition increase the risk of dementia. Other risk factors are, for example, high blood pressure , diabetes (diabetes mellitus), cardiac arrhythmias , high cholesterol levels , depression, craniocerebral injuries, smoking, excessive alcohol consumption and obesity .

People with low levels of mental, social and physical activity are also more prone to developing dementia.

Dementia: investigations and diagnosis

The fact that one often forgets something in old age is not necessarily a cause for concern. However, if your forgetfulness persists for months or even increases, you should see your family doctor. He can refer you to a specialist (neurological practice or memory clinic) if you suspect dementia.

anamnesis interview

The doctor will first ask you about your symptoms and your general state of health. He will also ask if you are taking any medication and if so, which ones. Because many preparations can temporarily or permanently impair brain performance. During this anamnesis interview , the doctor also pays attention to how well you can concentrate on the conversation.

The doctor often talks to close relatives. He asks her, for example, whether the patient is more restless or aggressive than before, is very active at night, or has hallucinations. 

Cognitive Dementia Tests

With the help of various tests, the doctor can determine whether you are suffering from dementia and how severe it is. Commonly used dementia tests include the clock test , MMST and DemTect . They are easy to perform and don’t take much time. However, their informative value in mild and questionable dementia is limited. In addition, these short cognitive tests are not suitable for differentiating between different types of dementia.

watch test

The watch test helps to detect dementia early. To do this, however, it is always combined with another test: the result of the watch test alone is not sufficient for a diagnosis.

The procedure for the watch test is very simple: you are asked to enter the numbers 1 to 12 in a circle, as they are arranged on a clock face. You should also draw the hour and minute hands in such a way that they result in a specific time (eg 11:10 am).

During the evaluation, the doctor checks, for example, whether the numbers and pointers are drawn correctly and whether the digits are easy to read. He can draw conclusions about possible dementia from mistakes and deviations. For example, people with the onset of dementia often place the minute hand incorrectly but the hour hand correctly.

MMST

The abbreviation MMST stands for “Mini Mental Status Test”. This is a very common dementia test. They have to fill out a simple questionnaire that tests various brain functions such as memory, attention and arithmetic. Your orientation skills will also be tested with questions such as “What time of year is it?” or “In which town are we right now?”. Each answer is evaluated with a number of points.

At the end of the test, all the points obtained are added up. Based on the result, the severity of dementia is estimated. With regard to Alzheimer’s – by far the most common form of dementia – a distinction is made between the following dementia stages:

  • MMST 20 to 26 points: mild Alzheimer’s dementia
  • MMST 10 to 19 points: moderate/moderate Alzheimer’s dementia
  • MMST < 10 points: severe Alzheimer’s dementia

You can find out more about the procedure and the evaluation of the “Mini-Mental-Status-Test” in the article  MMSE .

DemTect

The abbreviation DemTect stands for “Dementia Detection”. The approximately ten-minute test examines various cognitive abilities such as memory. Ten terms are read out to you (dog, lamp, plate, etc.), which you then have to repeat. The order doesn’t matter. It counts how many of the terms you could remember.

Another task is to list as many things as possible that can be bought in a supermarket. This tests the semantic verbal fluency.

Points are awarded for each task. At the end of the test, all the points are added up. The overall result can be used to estimate whether and how severely your cognitive performance is impaired.

Read more about this test procedure in the article  DemTect

Physical examination

A physical exam is important to rule out other medical conditions as the cause of the suspected dementia symptoms. It also allows you to determine your physical condition. For example, the doctor will measure your blood pressure, check your muscle reflexes and how your pupils react to light.

laboratory tests

Blood tests are also part of the dementia diagnosis . The blood count is created and various blood values ​​​​determined ( electrolytes such as sodium and potassium , fasting blood sugar, blood sedimentation , urea, vitamin B12 , thyroid values ​​, gamma-GT etc.). In this way, it can be determined whether secondary dementia may be present, for example caused by a thyroid disorder or a vitamin B12 deficiency.

In some cases, more extensive laboratory tests are necessary, for example when the dementia patient is remarkably young or the symptoms progress very quickly. Then the doctor orders, for example, a drug screening, urine tests and/or a test for Lyme disease , syphilis and HIV.

If the anamnesis and previous examinations led to the suspicion of an inflammatory brain disease, a sample of the cerebrospinal fluid ( liquor ) should be taken from the lumbar spine ( lumbar puncture ) and analyzed in the laboratory. This can provide indications of Alzheimer’s disease: characteristic changes in the concentration of certain proteins (amyloid protein and tau protein) in the cerebrospinal fluid indicate with a high degree of probability Alzheimer’s.

imaging procedures

Brain imaging tests are used to rule out treatable causes of dementia (such as a tumor). They also help to differentiate between the different forms of primary dementia (Alzheimer’s, vascular dementia, etc.).

Computer ( CT ) and magnetic resonance tomography (MRT, also known as nuclear spin tomography ) are mainly used . Sometimes other tests are done as well. This includes, for example, an ultrasound examination of the neck vessels if vascular dementia is suspected. In unclear cases of Lewy body dementia, a nuclear medicine examination can be useful (positron emission tomography = PET , single photon emission computed tomography = SPECT ).

genetic examination

If there is a suspicion that the dementia is hereditary, the patient should be offered genetic counseling and testing. The result of the genetic test has no influence on the therapy. However, some patients want to know exactly whether they actually carry a disease-causing gene or not.

Dementia: treatment

Despite various treatment options for dementia, the disease is usually not curable (exception: some secondary dementia). Instead, therapy aims to relieve symptoms and slow the progression of the disease. This helps patients to lead an independent and self-determined life for as long as possible.

Dementia therapy consists of drug treatment and non-drug measures . An individually tailored treatment plan is created for each patient. The personality and wishes of the patient should be taken into account, especially when choosing non-drug measures. The chances of success of the treatment are greater the earlier the therapy is started.

Dementia medication (antidementia)

So-called anti-dementia drugs are primarily used in drug therapy for dementia. They influence various messenger substances in the brain. This allows them to maintain the mental performance of the patients. However, anti-dementia drugs usually only work for a limited time.

Anti-dementia drugs have been tested primarily in the treatment of Alzheimer’s disease. Approved representatives are acetylcholinesterase inhibitors and the glutamate antagonist (NMDA antagonist) memantine.

Acetylcholinesterase inhibitors (such as donepezil or rivastigmine) inhibit an enzyme in the brain that breaks down the neurotransmitter acetylcholine. This messenger substance is important for communication between nerve cells. It is not produced in sufficient amounts in Alzheimer’s patients, which contributes to the symptoms. Acetylcholinesterase inhibitors can compensate for this neurotransmitter deficiency in the early and middle stages of Alzheimer’s. Then patients can master their everyday life better again. In addition, brain functions such as thinking, learning and remembering are preserved for longer.

Acetylcholinesterase inhibitors are also often used in other forms of the disease, such as Lewy body dementia and mixed forms.

The glutamate antagonist memantine blocks the docking sites for the neurotransmitter glutamate in the brain. Its concentration can be increased in Alzheimer’s, for example, which in the long run destroys the nerve cells. Memantine protects against this irreversible nerve damage (neuroprotection). They are used in middle and late stages of Alzheimer’s disease.

Preparations based on the medicinal plant Ginkgo biloba are often recommended for dementia. They are considered less effective, but can be used as a supplement.

Other medications for dementia

When people find out they have dementia, they often develop a depressed mood. The death of brain cells themselves can also be responsible for depression. In such cases, the doctor may prescribe antidepressants . They have a mood-enhancing and drive-enhancing effect.

Some patients become aggressive and restless, suffer from hallucinations or paranoia. Such symptoms can be relieved with neuroleptics (such as risperidone , melperone or pipamperone ). However, due to the strong side effects, the use of these drugs is being checked very carefully and limited in time.

In vascular dementia, risk factors and underlying diseases that can lead to further vascular damage should be treated. This includes, for example, the administration of antihypertensive drugs for high blood pressure and lipid-lowering drugs for elevated blood lipid levels (such as elevated cholesterol levels).

behavior therapy

The diagnosis of dementia triggers insecurity, fear, depression or aggressiveness in many people. A psychologist or psychotherapist can help those affected to better deal with their illness as part of behavioral therapy. Behavioral therapy is therefore particularly suitable for patients in the early stages of dementia.

cognitive training

Cognitive training can slow down the progression of dementia, especially in the early and middle stages of the disease. Mental (cognitive) abilities are trained, for example memory, attention and orientation. In individual or group therapy, for example, patients have to guess terms, name colors and add rhymes. The cognitive training should be designed for each patient in such a way that it represents neither too little nor too much effort.

autobiographical work

Autobiographical work can be useful in the early to middle stages of dementia: In discussions (individual or group therapy), the patient should use photos, books and personal items to build on earlier positive experiences and tell about them. This autobiographical work keeps alive a dementia patient’s memories of his past life and strengthens his sense of his own identity.

reality orientation

In reality orientation, patients train to orient themselves spatially and temporally and to better classify people and situations. Time orientation can be supported with clocks, calendars and pictures of the seasons. So that patients can find their way around better (eg in their home), the different living rooms (bathroom, kitchen, bedroom, etc.) can be marked with different colors.

Reality orientation makes sense in all stages of the disease. It can be trained individually or in groups.

music therapy

The purpose of music therapy in dementia is based on the fact that music can evoke positive memories and feelings. In the early stages of dementia, patients can play an instrument (drum, triangle, glockenspiel, etc.) or sing – individually or together. In advanced dementia, at least listening to familiar tunes can calm a patient down or ease their pain.

occupational therapy

In order for patients in the early to middle stages of dementia to be able to carry out everyday activities such as shopping, cooking or reading the newspaper for as long as possible, they should practice these activities regularly with a therapist.

In moderate to severe stages of the disease, dancing, massage, and touch can encourage physical activity. This can bring joy to the patient and improve their well-being.

environment therapy

Milieu therapy is about shaping the patient’s environment in a way that is appropriate for dementia. Those affected should feel safe and comfortable in their homes and living spaces. The rooms should therefore be designed as appropriately as possible. For example, most patients find smooth wood and soft fabrics very comfortable. Familiar scents (such as room scents) and favorite flowers can bring joy to patients, calm them down or cheer them up and awaken good memories. 

Care planning: dementia

Sooner or later, dementia patients will need help in everyday life, for example with dressing, washing, shopping, cooking and eating. Patients and their relatives should therefore deal with the topic as early as possible and take care of planning future care.

Important questions that need to be clarified are, for example: Can and does the person with dementia stay in their own home? What help does he need in his everyday life? Who can provide this help? What outpatient care options are there? If care at home is not possible – what alternatives are there?

You can read everything important about topics such as care in the family, outpatient care workers and nursing homes in the article Care  planning: Dementia .

dealing with dementia

When one’s own mental performance decreases noticeably, this is frustrating and frightening for many of those affected. Relatives often find it difficult to cope with dementia and its consequences.

Above all, dealing with dementia requires patience and understanding – both from the patient himself and from the relatives and caregivers. In addition, there is much that can be done to slow down mental decline. This includes regularly training existing cognitive skills, for example by reading or solving crossword puzzles. You should also continue other hobbies such as knitting, dancing or building model airplanes – if necessary with necessary adjustments (such as lighter knitting patterns or simpler dances).

Last but not least, dementia patients also benefit from a balanced diet, regular exercise and a structured daily routine.

You can read more tips for everyday life with dementia in the article  dealing with dementia .

help with dementia

There are many different associations, institutions and organizations that offer information and support to people with dementia and their families. These include, for example, the German Alzheimer Society, the German Seniors’ League and the “Friends of Older People” association.

Anyone who would like to convert their own home in a meaningful way for an elderly person or someone suffering from dementia can contact the Federal Working Group on Housing Adaptation eV for tips and information. If it is necessary to move to a retirement or nursing home, Heimverzeichnis.de offers help in finding a suitable facility.

You can find more about these and other contact points for dementia patients and their relatives in the article  Help with dementia .

Dementia: course of the disease and prognosis

With any form of dementia, mental performance is lost in the long term. The patient’s personality is also irreversibly affected.

In individual cases, however, the course of dementia can vary greatly from patient to patient. It mainly depends on the type of disease. For example, vascular dementia often occurs suddenly and worsens in phases. In most cases, however, dementia begins insidiously and slowly progresses.

In addition, a dementia patient can sometimes have “good” and sometimes “bad” days. The patient’s condition may also vary over the course of the day. For many of those affected, dementia is more severe in the evening than during the day.

The behavior of dementia patients is also very different. Some patients become increasingly aggressive, while others remain friendly and calm. Some patients remain physically fit for a long time, while others become bedridden.

Overall, the course of dementia can vary greatly from person to person. It’s also difficult to predict.

influence the course of dementia

Dementia cannot be cured. With activation, employment and human attention, however, the quality of life of dementia patients can be significantly improved. In addition, the right therapy (medication and non-medication measures) can help to temporarily stop or at least slow down the progression of dementia.

Dementia: prevention

Many factors favor dementia. Avoiding these risk factors, or at least reducing them, helps prevent dementia.

For example, high blood pressure, elevated blood lipid levels and obesity should be treated – not only with medication, but also with the right lifestyle. For example, a Mediterranean diet appears to protect against dementia: it includes lots of fruit and vegetables, fish, olive oil and whole grain bread. Pork and dairy products, on the other hand, should only be consumed in moderation.

The brain and the rest of the body benefit from regular exercise at any age. Physical activity stimulates blood circulation and metabolism in the brain. As a result, the nerve cells are more active and network better. Sport and exercise in everyday life also lower blood pressure and cholesterol levels and prevent obesity, diabetes, heart attacks, strokes and depression. In addition, regular exercise keeps the vessels healthy, which protects against vascular dementia. But physical activity is not only suitable for prevention: Dementia patients also benefit from it.

“Brain training” is also recommended : like the muscles, the brain should also be challenged regularly. Cultural activities, mathematical puzzles or creative hobbies are suitable for this. Such mental activity at work and during leisure time can reduce the risk of dementia.

If you want to prevent dementia, you should also maintain social contacts . The more you socialize and exchange ideas with other people, the more likely it is that you will still be mentally fit in old age – an important protection against dementia .

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