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Fieldhouse JLP, van Paassen DN, van Engelen MPE, De Boer SCM, Hartog WL, Braak S, Schoonmade LJ, Schouws SNTM, Krudop WA, Oudega ML, Mutsaerts HJMM, Teunissen CE, Vijverberg EGB, Pijnenburg YAL. The pursuit for markers of disease progression in behavioral variant frontotemporal dementia: a scoping review to optimize outcome measures for clinical trials. Front Aging Neurosci 2024; 16:1382593. [PMID: 38784446 PMCID: PMC11112081 DOI: 10.3389/fnagi.2024.1382593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by diverse and prominent changes in behavior and personality. One of the greatest challenges in bvFTD is to capture, measure and predict its disease progression, due to clinical, pathological and genetic heterogeneity. Availability of reliable outcome measures is pivotal for future clinical trials and disease monitoring. Detection of change should be objective, clinically meaningful and easily assessed, preferably associated with a biological process. The purpose of this scoping review is to examine the status of longitudinal studies in bvFTD, evaluate current assessment tools and propose potential progression markers. A systematic literature search (in PubMed and Embase.com) was performed. Literature on disease trajectories and longitudinal validity of frequently-used measures was organized in five domains: global functioning, behavior, (social) cognition, neuroimaging and fluid biomarkers. Evaluating current longitudinal data, we propose an adaptive battery, combining a set of sensitive clinical, neuroimaging and fluid markers, adjusted for genetic and sporadic variants, for adequate detection of disease progression in bvFTD.
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Affiliation(s)
- Jay L. P. Fieldhouse
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Dirk N. van Paassen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Marie-Paule E. van Engelen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Sterre C. M. De Boer
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Willem L. Hartog
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Simon Braak
- Department of Psychiatry, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, Netherlands
| | | | - Sigfried N. T. M. Schouws
- Department of Psychiatry, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Welmoed A. Krudop
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Mardien L. Oudega
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, Netherlands
- GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Henk J. M. M. Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
| | - Charlotte E. Teunissen
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Neurochemistry Laboratory, Department of Laboratory Medicine, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
| | - Everard G. B. Vijverberg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
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de Boer SCM, Gossink F, Krudop W, Vijverberg E, Schouws S, Reus LM, Pijnenburg YAL, Dols A. Diagnostic Instability Over Time in the Late-Onset Frontal Lobe Syndrome: When Can We Say it's FTD? Am J Geriatr Psychiatry 2023; 31:679-690. [PMID: 37028983 DOI: 10.1016/j.jagp.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Distinguishing sporadic behavioral variant of frontotemporal dementia (bvFTD) from late-onset primary psychiatric disorders (PPD) remains challenging with the lack of robust biomarkers. An early bvFTD misdiagnosis in PPD cases and vice-versa is common. Little is known about diagnostic (in)stability over longer period of time. We investigated diagnostic instability in a neuropsychiatric cohort up to 8 years after baseline visit and identified which clinical hallmarks contribute to diagnostic instability. DESIGN Diagnoses of participants of the late-onset frontal lobe (LOF) study were collected from the baseline visit (T0) and the 2-year follow-up visit (T2). Clinical outcomes were retrieved 5-8 years after baseline visit (Tfinal). Endpoint diagnoses were categorized into bvFTD, PPD and other neurological disorders (OND). We calculated the total amount of participants that switched diagnosis between T0-T2 and T2-Tfinal. Clinical records of participants that switched diagnosis were assessed. RESULTS Of the 137 patients that were included in the study, the final diagnoses at Tfinal were bvFTD 24.1% (n = 33), PPD 39.4% (n = 54), OND 33.6% (n = 46) and unknown 2.9% (n = 4). Between T0 and T2, a total of 29 (21.2%) patients switched diagnosis. Between T2 and Tfinal, 8 (5.8%) patients switched diagnosis. Prolonged follow-up identified few cases with diagnostic instability. Major contributors to diagnostic instability where a nonconverting diagnosis of possible bvFTD and a probable bvFTD diagnosis based on informant-based history and an abnormal FDG-PET scan whilst having a normal MRI. CONCLUSION Considering these lessons, a FTD diagnosis remains stable enough to conclude that 2 years is sufficient to say if a patient with late-life behavioral disorder has FTD.
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Affiliation(s)
- Sterre C M de Boer
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands.
| | - Flora Gossink
- Reinier van Arkel, Geriatric and Hospital Psychiatric Centre (COZ) (FG), Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Welmoed Krudop
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands; Department of Psychology and Psychiatry, Antonius Ziekenhuis Utrecht (WK), Utrecht, The Netherlands
| | - Everard Vijverberg
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands
| | - Sigfried Schouws
- Department of Old Age Psychiatry (SS), GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry (SS), Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Lianne Maria Reus
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands; Center for Neurobehavioral Genetics (LMR), University of California, Los Angeles, Los Angeles, CA
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Neurology (SCDB, WK, EV, LMR, YALP), Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Neuroscience (SCDB, WK, EV, LMR, YALP), Neurodegeneration, Amsterdam, The Netherlands
| | - Annemiek Dols
- Department of Psychiatry (AD), UMC Utrecht Brain Center, University Utrecht, Utrecht, The Netherlands
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Morrow CB, Leoutsakos J, Yan H, Onyike C, Kamath V. Weight Change and Neuropsychiatric Symptoms in Alzheimer's Disease and Frontotemporal Dementia: Associations with Cognitive Decline. J Alzheimers Dis Rep 2023; 7:767-774. [PMID: 37662607 PMCID: PMC10473120 DOI: 10.3233/adr-230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 09/05/2023] Open
Abstract
Weight changes, neuropsychiatric symptoms (NPS), and cognitive decline often coincide in Alzheimer's disease (AD) and frontotemporal dementia (FTD); however, the direction of their relationship remains unclear. This study aims to clarify the connection between weight changes, NPS, and cognition in AD and FTD. We found that cognitive decline was associated with decreased body mass index (BMI) in AD, while BMI gain was associated with increased conversion to FTD. Elevated NPS were associated with decreased BMI in AD and increased BMI in FTD. Identifying early changes in NPS and BMI may facilitate the detection of cognitive decline, providing an opportunity for early intervention.
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Affiliation(s)
- Christopher B. Morrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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[Rare forms of dementia-Atypical variants of Alzheimer's dementia]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:121-126. [PMID: 36662356 DOI: 10.1007/s00108-022-01461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/21/2023]
Abstract
In Germany, around 1.8 million people currently suffer from dementia and the numbers are increasing. The main cause of dementia is Alzheimer's disease. This is classically manifested in the form of an amnestic syndrome but also encompasses various atypical variants, especially in younger patients and in the clinical routine are not always easy to recognize. These are described in this narrative review with case studies. Posterior cortical atrophy (PCA) presents with visual disorders, in the logopenic variants of primary progressive aphasia (lvPPA) impaired word retrieval is the main symptom, in the frontal variant of Alzheimer's disease behavioral disorders are prominent and in corticobasal syndrome (CBS) an akinetic rigid Parkinson's syndrome with alien limb phenomenon. As the clinical presentation of these atypical variants shows an overlap with other dementia disorders, the differential diagnosis is often challenging. In this context amyloid biomarkers can provide valuable services.
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Castro-Suarez S, Guevara-Silva E, Caparó-Zamalloa C, Osorio-Marcatinco V, Meza-Vega M, Miller B, Cornejo-Olivas M. Knowledge and Attitudes for the Management of Behavioral Variant of Frontotemporal Dementia. Front Neurol 2022; 12:786448. [PMID: 35087469 PMCID: PMC8787358 DOI: 10.3389/fneur.2021.786448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The diagnosis of the behavioral variant of frontotemporal dementia (bvFTD) can be especially challenging and is relatively underdiagnosed. There is scarce information on training and attitudes from care providers facing bvFTD in settings with limited resources. We aim to describe clinical knowledge and attitudes facing bvFTD from neurologists, psychiatrists, and residents in Peru. Methods: Potential participants received invitations by email to complete an online questionnaire. In addition, we reviewed 21 curricula from undergraduate medical schools' programs offered by the main schools of medicine in Peru during 2020 and 2021. Results: A total of 145 participants completed the survey. The responders were neurologists (51%), psychiatrists (25%), and residents in neurology or psychiatry (24%). Only 26% of the respondents acknowledged receiving at least one class on bvFTD in undergraduate medical training, but 66.6% received at least some training during postgraduate study. Participants identified isolated supportive symptoms for bvFTD; however, only 25% identified the possible criteria and 18% the probable bvFTD criteria. They identified MoCA in 44% and Frontal Assessment Battery (39%) as the most frequently used screening test to assess bvFTD patients. Memantine and Acetylcholinesterase inhibitors were incorrectly indicated by 40.8% of participants. Seventy six percentage of participants indicated that they did not provide education and support to the caregiver. The dementia topic was available on 95.2%, but FTD in only 19%. Conclusion: Neuropsychiatry medical specialists in Peru receive limited training in FTD. Their clinical attitudes for treating bvFTD require appropriate training focused on diagnostic criteria, assessment tools, and pharmacological and non-pharmacological management.
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Affiliation(s)
- Sheila Castro-Suarez
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Department of Neurology, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Erik Guevara-Silva
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - César Caparó-Zamalloa
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Victor Osorio-Marcatinco
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Maria Meza-Vega
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, San Francisco School of Medicine, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
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Morrow CB, Chaney GAS, Capuzzi D, Bakker A, Onyike CU, Kamath V. Hyperorality in Frontotemporal Dementia: Cognitive and Psychiatric Symptom Profiles in Early-Stage Disease. J Alzheimers Dis 2022; 89:1203-1209. [PMID: 36093697 DOI: 10.3233/jad-220443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hyperorality is a distinctive feature of the behavioral variant of frontotemporal dementia (bvFTD), but little is known about its significance in early-stage disease. This study examined the cognitive and psychiatric symptom profiles associated with hyperorality, using data from subjects with early-stage bvFTD enrolled in Alzheimer's Disease Research Centers. We found that hyperorality was not associated with cognitive performance, but was associated with psychosis, elation, and disinhibition. Hyperorality may share neurobiology with a subset of early psychiatric symptoms, a finding which could help identify targets for future treatment.
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Affiliation(s)
- Christopher B Morrow
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Daniel Capuzzi
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Arnold Bakker
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi U Onyike
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vidyulata Kamath
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Loi SM, Tsoukra P, Chen Z, Wibawa P, Eratne D, Kelso W, Walterfang M, Velakoulis D. Risk factors to mortality and causes of death in frontotemporal dementia: An Australian perspective. Int J Geriatr Psychiatry 2021; 37. [PMID: 34921446 DOI: 10.1002/gps.5668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Frontotemporal dementia (FTD) is a common cause of dementia in younger people. There is less information known about risk factors to mortality such as the type of symptom onset and cause of death in this group. METHOD This was a retrospective file review of inpatients with FTD admitted to a tertiary neuropsychiatry unit located in Australia from 1992 to 2014. Mortality information including linkage of names and causes of death were obtained from the Australian Institute Health and Welfare National Death Index. RESULTS One hundred inpatients were diagnosed with FTD, including behavioural-variant, language-variant FTDs and FTD-motor neuron disease (FTD-MND). Mean age was 52.8 years (SD = 10, range 31-76 years). Sixty-seven of them had died at linkage. Median survival of the sample was 10.5 years and FTD-MND had the shortest survival, 3.5 years. Increasing age of onset and FTD-MND were found to be significant predictors of association for mortality. Compared to the general population, having a FTD had an 8× increased risk of death. Females had double the standardised mortality ratio compared to males. DISCUSSION This study provides important prognostic information for people diagnosed with FTD living in Australia. It highlights the importance of obtaining a definitive diagnosis as early as possible for future planning. More investigation into the relationship of symptom onset type and sex differences in FTD is required.
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Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Zhibin Chen
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Pierre Wibawa
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
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