ABSTRACT NUMBER: ESOC2026LB94 COGNITIVE VULNERABILITY AFTER TRANSIENT ISCHEMIC ATTACK AND MINOR STROKE WITH ELECTROENCEPHALOGRAPHIC MARKERS MISSED BY ROUTINE FOLLOW UP

Abstract Background and aims Patients with transient ischemic attack (TIA) and minor ischemic stroke are often discharged as recovered, relying largely on imaging and cognitive screening. Yet in practice, many patients later report cognitive problems that still are under-recognised in routine stroke follow-up. Methods We performed a systematic review using MEDLINE, Embase, and Web of Science to find studies examining EEG, quantitative EEG (qEEG), or event-related potentials (ERP) in adults with TIA or minor ischemic stroke. Studies reporting neurophysiological measures with cognitive or functional outcomes were included. Ten datasets (four ERP-based and six qEEG-based) were analysed to explore associations between EEG abnormalities, cognitive performance, and stroke severity. Results Across the studies reviewed, patients with minimal neurological deficits and preserved MoCA or MMSE scores showed neurophysiological changes suggestive of impaired cognitive processing. ERP studies consistently found prolonged P300 latency and decreased amplitudes indicating slowed information processing despite apparent clinical recovery. qEEG studies showed increased slow-frequency activity and reduced alpha power. It correlated with stroke severity measures and poorer cognitive outcomes. Importantly, EEG abnormalities were seen even when neuroimaging showed little or no injury which points to a patient subgroup at risk for under-recognised post-stroke cognitive impairment. Conclusions EEG-based measures can detect early cognitive problems after TIA and minor ischemic stroke that are frequently missed by routine screening and imaging. These findings challenge the idea that so-called minor cerebrovascular events have harmless cognitive consequences. Neurophysiological assessment in post-TIA management, and minor stroke follow-up may help risk stratification and cognitive monitoring. It provides a clinically relevant step in stroke aftercare. Conflict of interest