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We created an automated analysis platform to quantify A\u03b2 load and reactive microglia in the vicinity of A\u03b2 plaques and to evaluate their association with cognitive outcome in cortical biopsies of patients with iNPH obtained at the time of shunting. Aiforia Create deep learning software was used on whole slide images of Iba1\/4G8 double immunostained frontal cortical biopsies of 120 shunted iNPH patients to identify Iba1-positive microglia somas and A\u03b2 areas, respectively. Dementia, AD clinical syndrome (ACS), and Clinical Dementia Rating Global score (CDR-GS) were evaluated retrospectively after a median follow-up of 4.4\u2009years. Deep learning artificial intelligence yielded excellent (&amp;gt;95%) precision for tissue, A\u03b2, and microglia somas. Using an age-adjusted model, higher A\u03b2 coverage predicted the development of dementia, the diagnosis of ACS, and more severe memory impairment by CDR-GS whereas measured microglial densities and A\u03b2-related microglia did not correlate with cognitive outcome in these patients. Therefore, cognitive outcome seems to be hampered by higher A\u03b2 coverage in cortical biopsies in shunted iNPH patients but is not correlated with densities of surrounding microglia.<\/jats:p>","DOI":"10.1093\/jnen\/nlae083","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T11:42:16Z","timestamp":1722858136000},"page":"967-978","source":"Crossref","is-referenced-by-count":4,"title":["Deep learning assisted quantitative analysis of A\u03b2 and microglia in patients with idiopathic normal pressure hydrocephalus in relation to cognitive outcome"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2864-1953","authenticated-orcid":false,"given":"Antti J","family":"Luikku","sequence":"first","affiliation":[{"name":"Institute of Clinical Medicine\u2014Neurosurgery, University of Eastern Finland , Kuopio,","place":["Finland"]},{"name":"Neurosurgery of NeuroCenter, Kuopio University Hospital , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2401-9078","authenticated-orcid":false,"given":"Ossi","family":"Nerg","sequence":"additional","affiliation":[{"name":"Neurology of NeuroCenter, Kuopio University Hospital , Kuopio,","place":["Finland"]},{"name":"Institute of Clinical Medicine\u2014Neurology, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M","family":"Koivisto","sequence":"additional","affiliation":[{"name":"Neurology of NeuroCenter, Kuopio University Hospital , Kuopio,","place":["Finland"]},{"name":"Institute of Clinical Medicine\u2014Neurology, University of Eastern Finland , Kuopio,","place":["Finland"]},{"name":"Department of Neurosciences, University of Helsinki, Helsinki University Hospital , Helsinki,","place":["Finland"]},{"name":"Department of Geriatrics\/Rehabilitation and Internal Medicine, University of Helsinki, Helsinki University Hospital , Helsinki,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomo","family":"H\u00e4nninen","sequence":"additional","affiliation":[{"name":"Neurology of NeuroCenter, Kuopio University Hospital , Kuopio,","place":["Finland"]},{"name":"Institute of Clinical Medicine\u2014Neurology, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-1749","authenticated-orcid":false,"given":"Antti","family":"Junkkari","sequence":"additional","affiliation":[{"name":"Neurosurgery of NeuroCenter, Kuopio University Hospital , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Kemppainen","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sini-Pauliina","family":"Juopperi","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Sinisalo","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alli","family":"Pesola","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine\u2014Neurosurgery, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilkka","family":"Soininen","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine\u2014Neurology, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Hiltunen","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine, University of Eastern Finland , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ville","family":"Leinonen","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine\u2014Neurosurgery, University of Eastern Finland , Kuopio,","place":["Finland"]},{"name":"Neurosurgery of NeuroCenter, Kuopio University Hospital , Kuopio,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomas","family":"Rauramaa","sequence":"additional","affiliation":[{"name":"Department of Pathology, Kuopio University Hospital , Kuopio,","place":["Finland"]},{"name":"Institute of Clinical Medicine\u2014Pathology, University of Eastern Finland , 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