The prevalence of apathy is high after stroke, but its subsequent course remains unclear. We sought to determine the longitudinal course and predictors of apathy after stroke. Eligible patients admitted after a stroke and healthy control participants who were rated at least once on the Apathy Evaluation Scale were assessed over 5 years. Rates and levels of apathy in patients rose over 5 years. Significant risk factors for apathy were dementia, interval cerebrovascular events, poor physical functioning, and high depression scores. Apathy is common after stroke and becomes more prevalent with time, especially in those who show evidence of cognitive and functional decline.