Objective: To evaluate the clinical efficacy of low-frequency transcranial magnetic stimulation (TMS) combined with mirror therapy (MT) in patients with hemiplegia and cognitive impairment following hemorrhagic stroke.Methods: Between February 2022 and February 2025, 92 patients with hemiplegia and cognitive impairment following hemorrhagic stroke admitted to our hospital were enrolled. They were randomly assigned to either the TMS group or the combined group, each comprising 46 subjects. The TMS group received conventional therapy plus low-frequency TMS, while the combined group added mirror therapy to the TMS regimen. Upper limb motor function, balance function, neurophysiological indicators, cognitive function, and activities of daily living were compared between the two groups. Results: Baseline upper limb FMA, BBS, MMSE, MBI scores, MEP amplitude, and CMCT were comparable between the TMS and combined groups, with no statistically significant differences (P > 0.05). After 4 weeks of treatment and 1 month post-treatment, both groups showed significant improvements in upper limb FMA, BBS, MMSE, and MBI scores compared to baseline (P < 0.05). Post-treatment scores in the combined group were significantly higher than those in the TMS group (P < 0.05). Additionally, at 4 weeks and 1 month post-treatment, the combined group showed greater improvements in MEP amplitude and CMCT (P < 0.05). Conclusion: Combined TMS and MT therapy promotes upper limb motor function and balance recovery in patients with hemiplegia and cognitive impairment following hemorrhagic stroke. It improves neuroelectrophysiological indicators, enhances cognitive function, and increases activities of daily living capabilities.