Objective: The present study aimed to investigate the association between iron metabolism, ferroptosis, cerebrospinal fluid (CSF) iron ion levels, and cognitive impairment in patients with intracerebral hemorrhage (ICH). Methods: A total of 80 ICH patients treated at the Department of Neurology and Emergency Department of our hospital were included in the study. Additionally, 36 patients with external brain injury (without intracerebral hemorrhage) were recruited as a control group. Magnetic resonance imaging (MRI) was used to assess the location and extent of intracerebral bleeding in the observation group (ICH group). Results: The protein expressions of GPX4 and FSP1 were found to be elevated in the ICH group (P < 0.05). Similarly, the expressions of iron metabolism-related proteins, including transferrin, ferritin, and ferritransporters, were significantly higher in the brain tissue of the ICH group (P < 0.05). Malondialdehyde (MDA) levels were also elevated in the ICH group (MDA: 4.45 +/- 0.47 vs. 3.31 +/- 0.35 nmol/ml). Furthermore, the level of iron ions in the CSF was higher in the ICH group (P < 0.05). Cognitive assessments showed that MMSE and MoCA scores in the ICH group were significantly lower than those in the control group (P < 0.05), indicating more severe cognitive impairment in the observation group. Moreover, MMSE and MoCA scores were negatively correlated with iron metabolism-related proteins (transferrin, ferritin, and ferritransporters), ferroptosis markers (GPX4 and FSP1), and CSF iron ion levels (P < 0.05). Conclusion: Disturbances in iron metabolism, the occurrence of ferroptosis, and increased CSF iron ion levels in ICH patients appear to be closely associated with cognitive impairment.