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This is an insult. The pejorative refers to an [extremely] [stupid person] who, while not actually having Down's Syndrome, has an [intelligence] equated to that of someone who suffers from that genetic ailment. It is usually used to attack someone who has made a grave error in speech or action, or holds beliefs or takes actions not to the insulter's liking. Many would object to this term because of its implicit devaluing of persons with Down's Syndrome.
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