Objective To explore the correlation between metacognitive characteristics and severity of post stroke fatigue （PSF） in patients. Methods A total of 56 inpatients with first-episode acute cerebral infarction admitted to the Wuxi Eighth People's Hospital， Jiangsu Province from November 2018 to June 2023 were selected as the study subjects. Patients with Fatigue Severity Scale （FSS） scores ≥ 4 were categorized into the PSF group （n=28）， and those with scores ＜ 4 were categorized into the non-PSF group （n=28）. The scores of the National Institutes of Health Stroke Scale （NIHSS）， Brief Mental Status Examination （MMSE）， FSS， Metacognition Assessment Scale Abbreviated （MAS-A）， and the Hopkins Verbal Learning Test-Revised （HVLT-R） were compared between the two groups， as well as the time to completion of the Trail Making Test （TMT）. Spearman correlation was used to analyze the correlation between Fatigue Severity Scale （FSS） score and Metacognition Assessment Scale Abbreviated （MAS-A） total score， Trail Making Test（TMT）-A and TMT-B in patients with PSF. Results There were statistically significant differences in the scores of FSS and NIHSS between the two groups （P＜ 0.05）. The total MAS-A score， self-reflection score， understanding others score， decentralization score， control score and HVLT-R score of patients in the PSF group were lower than those in the non-PSF group， and the difference were statistically significant （P＜0.05）. TMT-A and TMT-B usage time of patients in the PSF group were higher than those in the non-PSF group， with statistically significant differences （P ＜ 0.05）. Spearman correlation showed that the usage time of TMT-A and TMT-B was positively correlated with FSS score（r=0.354，0.426；P ＜ 0.05）， while the total score of MAS-A was negatively correlated with FSS score（r=-0.314，P ＜ 0.05）. Conclusions PSF patients have metacognitive impairment and cognitive impairment， especially in learning， memory， and executive functions.