Objective To investigate the association between cognitive and emotional impairment and early apathy in patients with non-disabling ischemic cerebrovascular events (NICE). Methods A total of 244 NICE patients, 156 males and 88 females, aged (63.1±9.7) years, admitted to The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jun. 2021 to Dec. 2022 were enrolled. Based on the apathy evaluation scale-clinician version (AES-C) scores at admission, patients were categorized into apathy group (score ≥ 33, n=64) and non-apathy group (score<33, n=180). Demographic data, blood test results, and imaging data were collected. According to the imaging examination results, the etiology was divided into transient ischemic attack and mild stroke, and the latter was further classified using the Trial of Org 10172 Acute Stroke Treatment (TOAST). The Fazekas scale was used to evaluate the white matter damage. Within 2 weeks of symptom onset, assessments including the Pittsburgh sleep quality index (PSQI), Montreal cognitive assessment (MoCA), auditory verbal learn test (AVLT), digit span test (DST), digit symbol substitution test (DDST), trail making test (TMT), Hamilton depression rating scale (HAMD), and Hamilton anxiety rating scale (HAMA) were conducted. The differences of the general information and indicators between the 2 groups were compared, and multivariate logistic regression analysis was performed to identify factors influencing apathy. Results The incidence of early apathy in NICE patients was 26.2% (64/244). Compared with the non-apathy group, the patients in the apathy group were older, and had lower body mass index (BMI) and lower level of education (all P<0.05). There were no significant differences in gender, smoking, alcohol consumption, or history of hypertension between the 2 groups (all P>0.05). The results of the first blood test at admission indicated that there was no significant difference in thyroid hormone levels between the 2 groups (P>0.05), and the imaging evaluation results showed that there was no difference in the etiology between the 2 groups (all P>0.05). The results of Fazekas score showed that the degree of white matter injury in the apathy group was significantly higher than that in the non-apathy group (P=0.004). The cognitive function test results indicated that the apathy group had a significantly higher prevalence of cognitive impairment (MoCA total score<26) than that in the non-apathy group (46.1% [83/180] vs 59.4% [38/64], P=0.047). The language function, verbal fluency, abstraction, delayed recall, and orientation of the patients in the apathy group were significantly decreased (all P<0.05), while no significant differences were found in visuospatial/executive function, naming, or attention between the 2 groups (all P>0.05). Furthermore, the apathy group had higher PSQI, HAMA, and HAMD scores compared to the non-apathy group, accompanied by significantly prevalences of sleep disorders, anxiety, and depression (all P<0.05). Multivariate logistic regression analysis revealed that HAMD score, age, and the completion time of TMT-A were risk factors of apathy after NICE (all P<0.05). Conclusion Patients with early apathy have a higher prevalence of cognitive impairment and are more susceptible to sleep disorders, anxiety, and depression. HAMD score, age, and the completion time of TMT-A are risk factors of early apathy after NICE.