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image of Neuropsychological Aspects of Sporadic Cerebral Amyloid Angiopathy: A Case Series and Narrative Review

Abstract

Introduction

Cerebral Amyloid Angiopathy (CAA) is a common form of cerebral small vessel disease (CSVD), characterized by the accumulation of amyloid-β (Aβ) protein in the walls of cortical and leptomeningeal arteries and arterioles. The sporadic form primarily affects the elderly and is closely associated with Alzheimer’s disease (AD). Despite previous studies on cognition, the specific neuropsychological profile of CAA remains unclear. This study aims to describe the cognitive profile of CAA patients and characterize their neuropsychological aspects in the absence of a clinical diagnosis of AD.

Methods

We present a case series of six patients with probable CAA, without clinical evidence of AD, who underwent extensive neuropsychological assessment. Additionally, a narrative review was conducted to synthesize current knowledge of the cognitive and neuropsychological aspects of sporadic CAA.

Results

The narrative review indicates that CAA predominantly affects executive functioning, processing speed, episodic memory, global cognition, and visuospatial functions. In our case series, all patients exhibited impairments in these domains, except for global cognition. Notably, a specific dissociation was observed in the Rey Auditory Verbal Learning Test (RAVLT), with impaired delayed recall but preserved recognition.

Discussion

Sporadic CAA in patients without AD contributes to cognitive impairment, particularly affecting executive functioning, processing speed, visuospatial functions, and episodic memory. In our sample, memory impairment in CAA follows a dysexecutive pattern, characterized by retrieval deficits with preserved storage. This contrasts with the amnestic profile seen in AD and amnestic mild cognitive impairment (aMCI), where both retrieval and storage are compromised.

Conclusion

This distinct memory profile may represent a useful neuropsychological marker for differentiating CAA-related cognitive impairment from that associated with AD and its prodromal forms. This differentiation has potential implications for diagnosis, prognosis, and the development of tailored therapeutic strategies.

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2025-08-18
2025-09-16
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References

  1. Pantoni L. Cerebral small vessel disease: From pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010 9 7 689 701 10.1016/S1474‑4422(10)70104‑6 20610345
    [Google Scholar]
  2. Cozza M. Amadori L. Boccardi V. Exploring cerebral amyloid angiopathy: Insights into pathogenesis, diagnosis, and treatment. J. Neurol. Sci. 2023 454 8 120866 10.1016/j.jns.2023.120866 37931443
    [Google Scholar]
  3. Viswanathan A. Greenberg S.M. Cerebral amyloid angiopathy in the elderly. Ann. Neurol. 2011 70 6 871 880 10.1002/ana.22516 22190361
    [Google Scholar]
  4. Jäkel L. De Kort A.M. Klijn C.J.M. Schreuder F.H.B.M. Verbeek M.M. Prevalence of cerebral amyloid angiopathy: A systematic review and meta‐analysis. Alzheimers Dement. 2022 18 1 10 28 10.1002/alz.12366 34057813
    [Google Scholar]
  5. Charidimou A. Boulouis G. Frosch M.P. The Boston criteria version 2.0 for cerebral amyloid angiopathy: A multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol. 2022 21 8 714 725 10.1016/S1474‑4422(22)00208‑3 35841910
    [Google Scholar]
  6. Malhotra K. Theodorou A. Katsanos A.H. Prevalence of clinical and neuroimaging markers in cerebral amyloid angiopathy: A systematic review and meta-analysis. Stroke 2022 53 6 1944 1953 10.1161/STROKEAHA.121.035836 35264008
    [Google Scholar]
  7. Wermer M.J.H. Greenberg S.M. The growing clinical spectrum of cerebral amyloid angiopathy. Curr. Opin. Neurol. 2018 31 1 28 35 10.1097/WCO.0000000000000510 29120920
    [Google Scholar]
  8. Greenberg S.M. Vonsattel J.P.G. Stakes J.W. Gruber M. Finklestein S.P. The clinical spectrum of cerebral amyloid angiopathy. Neurology 1993 43 10 2073 2079 10.1212/WNL.43.10.2073 8413970
    [Google Scholar]
  9. Pfeifer L.A. White L.R. Ross G.W. Petrovitch H. Launer L.J. Cerebral amyloid angiopathy and cognitive function. Neurology 2002 58 11 1629 1634 10.1212/WNL.58.11.1629 12058090
    [Google Scholar]
  10. Haussmann R. Homeyer P. Sauer C. Comorbid cerebral amyloid angiopathy in dementia and prodromal stages—Prevalence and effects on cognition. Int. J. Geriatr. Psychiatry 2023 38 10 6015 10.1002/gps.6015 37847104
    [Google Scholar]
  11. Arvanitakis Z. Leurgans S.E. Wang Z. Wilson R.S. Bennett D.A. Schneider J.A. Cerebral amyloid angiopathy pathology and cognitive domains in older persons. Ann. Neurol. 2011 69 2 320 327 10.1002/ana.22112 21387377
    [Google Scholar]
  12. Boyle P.A. Yu L. Nag S. Cerebral amyloid angiopathy and cognitive outcomes in community-based older persons. Neurology 2015 85 22 1930 1936 10.1212/WNL.0000000000002175 26537052
    [Google Scholar]
  13. Reijmer Y.D. Fotiadis P. Martinez-Ramirez S. Structural network alterations and neurological dysfunction in cerebral amyloid angiopathy. Brain 2015 138 1 179 188 10.1093/brain/awu316 25367025
    [Google Scholar]
  14. Xiong L. Davidsdottir S. Reijmer Y.D. Cognitive profile and its association with neuroimaging markers of non-demented cerebral amyloid angiopathy patients in a stroke unit. J. Alzheimers Dis. 2016 52 1 171 178 10.3233/JAD‑150890 27060947
    [Google Scholar]
  15. Xiong L. van Veluw S.J. Bounemia N. Cerebral cortical microinfarcts on magnetic resonance imaging and their association with cognition in cerebral amyloid angiopathy. Stroke 2018 49 10 2330 2336 10.1161/STROKEAHA.118.022280 30355109
    [Google Scholar]
  16. Case N.F. Charlton A. Zwiers A. Cerebral amyloid angiopathy is associated with executive dysfunction and mild cognitive impairment. Stroke 2016 47 8 2010 2016 10.1161/STROKEAHA.116.012999 27338926
    [Google Scholar]
  17. Durrani R. Wang M. Cox E. Mediators of cognitive impairment in cerebral amyloid angiopathy. Int. J. Stroke 2023 18 1 78 84 10.1177/17474930221099352 35473418
    [Google Scholar]
  18. Vasquez B.P. Zakzanis K.K. The neuropsychological profile of vascular cognitive impairment not demented: A meta‐analysis. J. Neuropsychol. 2015 9 1 109 136 10.1111/jnp.12039 24612847
    [Google Scholar]
  19. Weintraub S. Wicklund A.H. Salmon D.P. The neuropsychological profile of Alzheimer disease. Cold Spring Harb. Perspect. Med. 2012 2 4 a006171 10.1101/cshperspect.a006171 22474609
    [Google Scholar]
  20. Planton M. Saint-Aubert L. Raposo N. High prevalence of cognitive impairment after intracerebral hemorrhage. PLoS One 2017 12 6 0178886 10.1371/journal.pone.0178886 28570698
    [Google Scholar]
  21. Subotic A. McCreary C.R. Saad F. Cortical thickness and its association with clinical cognitive and neuroimaging markers in cerebral amyloid angiopathy. J. Alzheimers Dis. 2021 81 4 1663 1671 10.3233/JAD‑210138 33998545
    [Google Scholar]
  22. van Dort R. Kaushik K. Rasing I. Cognition in (pre)symptomatic dutch‐type hereditary and sporadic cerebral amyloid angiopathy. Alzheimers Dement. 2024 20 11 7518 7528 10.1002/alz.14171 39387105
    [Google Scholar]
  23. Jo S. Cheong E.N. Kim N. Role of white matter abnormalities in the relationship between microbleed burden and cognitive impairment in cerebral amyloid angiopathy. J. Alzheimers Dis. 2022 86 2 667 678 10.3233/JAD‑215094 35124637
    [Google Scholar]
  24. Valenti R. Charidimou A. Xiong L. Visuospatial functioning in cerebral amyloid angiopathy: A pilot study. J. Alzheimers Dis. 2017 56 4 1223 1227 10.3233/JAD‑160927 28222510
    [Google Scholar]
  25. Su Y. Fu J. Zhang Y. Xu J. Dong Q. Cheng X. Visuospatial dysfunction is associated with posterior distribution of white matter damage in non‐demented cerebral amyloid angiopathy. Eur. J. Neurol. 2021 28 9 3113 3120 10.1111/ene.14993 34157199
    [Google Scholar]
  26. Schrag M. Kirshner H. Neuropsychological effects of cerebral amyloid angiopathy. Curr. Neurol. Neurosci. Rep. 2016 16 8 76 10.1007/s11910‑016‑0674‑1 27357378
    [Google Scholar]
  27. Planton M. Raposo N. Albucher J.F. Pariente J. Cerebral amyloid angiopathy-related cognitive impairment: The search for a specific neuropsychological pattern. Rev. Neurol. 2017 173 9 562 565 10.1016/j.neurol.2017.09.006 28993004
    [Google Scholar]
  28. Schiavolin S. Camarda G. Mazzucchelli A. Cognitive and psychological characteristics in patients with cerebral amyloid angiopathy: A literature review. Neurol. Sci. 2024 45 7 3031 3049 10.1007/s10072‑024‑07399‑7 38388894
    [Google Scholar]
  29. Chan E. Bonifacio G.B. Harrison C. Domain-specific neuropsychological investigation of CAA with and without intracerebral haemorrhage. J. Neurol. 2023 270 12 6124 6132 10.1007/s00415‑023‑11977‑8 37672105
    [Google Scholar]
  30. Barucci E. Salvadori E. Magi S. Cognitive profile in cerebral small vessel disease: Comparison between cerebral amyloid angiopathy and hypertension-related microangiopathy. Sci. Rep. 2024 14 1 5922 10.1038/s41598‑024‑55719‑w 38467658
    [Google Scholar]
  31. Hyman B.T. Phelps C.H. Beach T.G. National institute on aging-alzheimer’s association guidelines for the neuropathologic assessment of Alzheimer’s disease. Alzheimers Dement. 2012 8 1 1 13 10.1016/j.jalz.2011.10.007 22265587
    [Google Scholar]
  32. Schoemaker D. Charidimou A. Zotin Z.M.C. Association of memory impairment with concomitant tau pathology in patients with cerebral amyloid angiopathy. Neurology 2021 96 15 e1975 e1986 10.1212/WNL.0000000000011745 33627498
    [Google Scholar]
  33. Tsai H.H. Liu C.J. Lee B.C. Cerebral tau pathology in cerebral amyloid angiopathy. Brain Commun. 2024 6 2 fcae086 10.1093/braincomms/fcae086 38638152
    [Google Scholar]
  34. Rabin J.S. Nichols E. La Joie R. Cerebral amyloid angiopathy interacts with neuritic amyloid plaques to promote tau and cognitive decline. Brain 2022 145 8 2823 2833 10.1093/brain/awac178 35759327
    [Google Scholar]
  35. Godrich D. Pasteris J. Martin E.R. Cerebral amyloid angiopathy impacts neurofibrillary tangle burden and cognition. Brain Commun. 2024 6 6 fcae369 10.1093/braincomms/fcae369 39584156
    [Google Scholar]
  36. Theodorou A. Athanasaki A. Melanis K. Cognitive impairment in cerebral amyloid angiopathy: A single-center prospective cohort study. J. Clin. Med. 2024 13 23 7427 10.3390/jcm13237427 39685885
    [Google Scholar]
  37. De Kort A.M. Kaushik K. Kuiperij H.B. The relation of a cerebrospinal fluid profile associated with Alzheimer’s disease with cognitive function and neuropsychiatric symptoms in sporadic cerebral amyloid angiopathy. Alzheimers Res. Ther. 2024 16 1 99 10.1186/s13195‑024‑01454‑3 38704569
    [Google Scholar]
  38. Riley D.S. Barber M.S. Kienle G.S. CARE guidelines for case reports: Explanation and elaboration document. J. Clin. Epidemiol. 2017 89 218 235 10.1016/j.jclinepi.2017.04.026 28529185
    [Google Scholar]
  39. Fabrizi E. Ancidoni A. Locuratolo N. The Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment. Age Ageing 2024 53 11 afae250 10.1093/ageing/afae250 39544104
    [Google Scholar]
  40. Salvadori E. Brambilla M. Cova I. Pomati S. Pantoni L. Cognitive evaluation in cerebral small vessel disease: towards an evidence-based identification of the reference standards. Part 1. A systematic review and qualitative data synthesis. J. Neurol. 2021 268 12 4563 4572 10.1007/s00415‑020‑10262‑2 33048216
    [Google Scholar]
  41. Salvadori E. Brambilla M. Maestri G. The clinical profile of cerebral small vessel disease: Toward an evidence‐based identification of cognitive markers. Alzheimers Dement. 2023 19 1 244 260 10.1002/alz.12650 35362229
    [Google Scholar]
  42. Magni E. Binetti G. Bianchetti A. Rozzini R. Trabucchi M. Mini‐mental state examination: A normative study in Italian elderly population. Eur. J. Neurol. 1996 3 3 198 202 10.1111/j.1468‑1331.1996.tb00423.x 21284770
    [Google Scholar]
  43. Carlesimo G.A. Caltagirone C. Gainotti G. The mental deterioration battery: Normative data, diagnostic reliability and qualitative analyses of cognitive impairment. Eur. Neurol. 1996 36 6 378 384 10.1159/000117297 8954307
    [Google Scholar]
  44. Costa A. Bagoj E. Monaco M. Standardization and normative data obtained in the Italian population for a new verbal fluency instrument, the phonemic/semantic alternate fluency test. Neurol. Sci. 2014 35 3 365 372 10.1007/s10072‑013‑1520‑8 23963806
    [Google Scholar]
  45. Siciliano M. Chiorri C. Battini V. Regression-based normative data and equivalent scores for trail making test (TMT): An updated Italian normative study. Neurol. Sci. 2019 40 3 469 477 10.1007/s10072‑018‑3673‑y 30535956
    [Google Scholar]
  46. Caffarra P. Vezzadini G. Dieci F. Zonato F. Venneri A. Una versione abbreviata del test di Stroop: Dati normativi nella popolazione italiana. Riv. Neurol. 2002 12 4 111 115
    [Google Scholar]
  47. Monaco M. Costa A. Caltagirone C. Carlesimo G.A. Erratum to: Forward and backward span for verbal and visuo-spatial data: Standardization and normative data from an Italian adult population. Neurol. Sci. 2015 36 2 345 347 10.1007/s10072‑014‑2019‑7 25491661
    [Google Scholar]
  48. Aiello E.N. Esposito A. Gramegna C. The frontal assessment battery (FAB) and its sub-scales: Validation and updated normative data in an Italian population sample. Neurol. Sci. 2022 43 2 979 984 10.1007/s10072‑021‑05392‑y 34184168
    [Google Scholar]
  49. Caffarra P. Vezzadini G. Dieci F. Zonato F. Venneri A. Rey-Osterrieth complex figure: Normative values in an Italian population sample. Neurol. Sci. 2002 22 6 443 447 10.1007/s100720200003 11976975
    [Google Scholar]
  50. Ricci M. Ruggeri M. Gnisci C. Pizzoni L. Gerace C. Blundo C. Improving amnesia diagnostic accuracy with RAVLT single scores and composite indices: Italian normative data. Arch. Clin. Neuropsychol. 2022 37 8 1749 1764 10.1093/arclin/acac055 35870196
    [Google Scholar]
  51. Rey A. Rey auditory verbal learning test (RAVLT) L’Examen clinique en psychologie. Paris Presse Universitaires de France 1964
    [Google Scholar]
  52. Ricci M. Graef S. Blundo C. Miller L.A. Using the rey auditory verbal learning test (RAVLT) to differentiate Alzheimer’s dementia and behavioural variant fronto-temporal dementia. Clin. Neuropsychol. 2012 26 6 926 941 10.1080/13854046.2012.704073 22809061
    [Google Scholar]
  53. Vakil E. Blachstein H. Rey auditory-verbal learning test: Structure analysis. J. Clin. Psychol. 1993 49 6 883 890 10.1002/1097‑4679(199311)49:6<883:AID‑JCLP2270490616>3.0.CO;2‑6 8300877
    [Google Scholar]
  54. Lezak M.D. Howieson D.B. Bigler E.D. Tranel D. Neuropsychological Assessment. 5th ed New York Oxford University Press 2012 419 426
    [Google Scholar]
  55. Spinnler H. Tognoni G. Italian standardization and calibration of neuropsychological tests. Ital. J. Neurol. Sci. 1987 6 25 27
    [Google Scholar]
  56. Bennett I.J. Golob E.J. Parker E.S. Starr A. Memory evaluation in mild cognitive impairment using recall and recognition tests. J. Clin. Exp. Neuropsychol. 2006 28 8 1408 1422 10.1080/13803390500409583 17050267
    [Google Scholar]
  57. Greenaway M.C. Lacritz L.H. Binegar D. Weiner M.F. Lipton A. Munro Cullum C. Patterns of verbal memory performance in mild cognitive impairment, Alzheimer disease, and normal aging. Cogn. Behav. Neurol. 2006 19 2 79 84 10.1097/01.wnn.0000208290.57370.a3 16783130
    [Google Scholar]
  58. Wolk D.A. Signoff E.D. DeKosky S.T. Recollection and familiarity in amnestic mild cognitive impairment: A global decline in recognition memory. Neuropsychologia 2008 46 7 1965 1978 10.1016/j.neuropsychologia.2008.01.017 18328509
    [Google Scholar]
  59. Chang Y.L. Bondi M.W. Fennema-Notestine C. Brain substrates of learning and retention in mild cognitive impairment diagnosis and progression to Alzheimer’s disease. Neuropsychologia 2010 48 5 1237 1247 10.1016/j.neuropsychologia.2009.12.024 20034503
    [Google Scholar]
  60. Balthazar M.L.F. Yasuda C.L. Cendes F. Damasceno B.P. Learning, retrieval, and recognition are compromised in aMCI and mild AD: Are distinct episodic memory processes mediated by the same anatomical structures? J. Int. Neuropsychol. Soc. 2010 16 1 205 209 10.1017/S1355617709990956 19835661
    [Google Scholar]
  61. Russo M.J. Cohen G. Campos J. Usefulness of discriminability and response bias indices for the evaluation of recognition memory in mild cognitive impairment and alzheimer disease. Dement. Geriatr. Cogn. Disord. 2017 43 1-2 1 14 10.1159/000452255 27889770
    [Google Scholar]
  62. Russo M.J. Campos J. Vázquez S. Sevlever G. Allegri R.F. Adding recognition discriminability index to the delayed recall is useful to predict conversion from mild cognitive impairment to Alzheimer’s disease in the Alzheimer’s disease neuroimaging initiative. Front. Aging Neurosci. 2017 9 46 10.3389/fnagi.2017.00046 28344552
    [Google Scholar]
  63. Tomadesso C. de La Sayette V. de Flores R. Neuropsychology and neuroimaging profiles of amyloid‐positive versus amyloid‐negative amnestic mild cognitive impairment patients. Alzheimers Dement. 2018 10 1 269 277 10.1016/j.dadm.2018.02.008 29780872
    [Google Scholar]
  64. De Simone M.S. Perri R. Fadda L. Caltagirone C. Carlesimo G.A. Predicting progression to Alzheimer’s disease in subjects with amnestic mild cognitive impairment using performance on recall and recognition tests. J. Neurol. 2019 266 1 102 111 10.1007/s00415‑018‑9108‑0 30386876
    [Google Scholar]
  65. Goldstein F.C. Loring D.W. Thomas T. Saleh S. Hajjar I. Recognition memory performance as a cognitive marker of prodromal Alzheimer’s disease. J. Alzheimers Dis. 2019 72 2 507 514 10.3233/JAD‑190468 31594225
    [Google Scholar]
  66. De Simone M.S. Lombardi M.G. De Tollis M. Forgetting rate for the familiarity and recollection components of recognition in amnestic mild cognitive impairment: A longitudinal study. Appl. Neuropsychol. Adult 2024 31 6 1411 1423 10.1080/23279095.2022.2135441 36264763
    [Google Scholar]
  67. Delis D.C. Massman P.J. Butters N. Salmon D.P. Cermak L.S. Kramer J.H. Profiles of demented and amnesic patients on the California verbal learning test: Implications for the assessment of memory disorders. Psychol. Assess. 1991 3 1 19 26 10.1037/1040‑3590.3.1.19
    [Google Scholar]
  68. Clark L.R. Stricker N.H. Libon D.J. Yes/no versus forced-choice recognition memory in mild cognitive impairment and Alzheimer’s disease: Patterns of impairment and associations with dementia severity. Clin. Neuropsychol. 2012 26 7 1201 1216 10.1080/13854046.2012.728626 23030301
    [Google Scholar]
  69. Westerberg C. Mayes A. Florczak S.M. Distinct medial temporal contributions to different forms of recognition in amnestic mild cognitive impairment and Alzheimer’s disease. Neuropsychologia 2013 51 12 2450 2461 10.1016/j.neuropsychologia.2013.06.025 23831717
    [Google Scholar]
  70. Caruso G. Perri R. Fadda L. Caltagirone C. Carlesimo G.A. Recall and recognition in Alzheimer’s disease and frontotemporal dementia. J. Alzheimers Dis. 2020 77 2 655 666 10.3233/JAD‑200126 32741812
    [Google Scholar]
  71. Juhlin F. Mellqvist J. Eckerström M. Hellström P. Rey auditory verbal learning test in idiopathic normal pressure hydrocephalus and Alzheimer’s disease. Clin. Neuropsychol. 2024 38 1 202 218 10.1080/13854046.2023.2200977 37051850
    [Google Scholar]
  72. Looi J.C.L. Sachdev P.S. Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 1999 53 4 670 678 10.1212/WNL.53.4.670 10489025
    [Google Scholar]
  73. Sachdev P. Kalaria R. O’Brien J. Diagnostic criteria for vascular cognitive disorders: A VASCOG statement. Alzheimer Dis. Assoc. Disord. 2014 28 3 206 218 10.1097/WAD.0000000000000034 24632990
    [Google Scholar]
  74. Seki M. Yoshizawa H. Hosoya M. Kitagawa K. Neuropsychological profile of early cognitive impairment in cerebral small vessel disease. Cerebrovasc. Dis. 2022 51 5 600 607 10.1159/000522438 35378532
    [Google Scholar]
  75. Gleichgerrcht E. Torralva T. Martinez D. Roca M. Manes F. Impact of executive dysfunction on verbal memory performance in patients with Alzheimer’s disease. J. Alzheimers Dis. 2011 23 1 79 85 10.3233/JAD‑2010‑100990 20930305
    [Google Scholar]
  76. Consonni M. Rossi S. Cerami C. Executive dysfunction affects word list recall performance: Evidence from amyotrophic lateral sclerosis and other neurodegenerative diseases. J. Neuropsychol. 2017 11 1 74 90 10.1111/jnp.12072 25952058
    [Google Scholar]
  77. Melrose R.J. Zahniser E. Wilkins S.S. Prefrontal working memory activity predicts episodic memory performance: A neuroimaging study. Behav. Brain Res. 2020 379 112307 10.1016/j.bbr.2019.112307 31678217
    [Google Scholar]
  78. Libon D.J. Drabick D.A.G. Giovannetti T. Neuropsychological syndromes associated with Alzheimer’s/vascular dementia: A latent class analysis. J. Alzheimers Dis. 2014 42 3 999 1014 10.3233/JAD‑132147 25024329
    [Google Scholar]
  79. Hu H. Wan S. Hu Y. Wang Q. Li H. Zhang N. Deciphering the role of APOE in cerebral amyloid angiopathy: From genetic insights to therapeutic horizons. Ann. Med. 2025 57 1 2445194 10.1080/07853890.2024.2445194 39745195
    [Google Scholar]
  80. Doran S.J. Sawyer R.P. Risk factors in developing amyloid related imaging abnormalities (ARIA) and clinical implications. Front. Neurosci. 2024 18 1326784 10.3389/fnins.2024.1326784 38312931
    [Google Scholar]
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