The dynamic changes in vegetation significantly impact the sustainability, safety, and stability of ecosystems in the source region of the Yellow River. However, the spatiotemporal patterns and driving factors of these changes remain unclear. The MODIS NDVI dataset (1998–2018), together with climatic records from meteorological stations and socio-economic statistics, was collected to investigate the spatiotemporal characteristics of vegetation coverage in the study area. For the analysis, we employed linear trend analysis to assess long-term changes, Pearson correlation analysis to examine the relationships between vegetation dynamics and climatic as well as anthropogenic factors, and t-tests to evaluate the statistical significance of the results. The results indicated the following: (1) From 1998 to 2018, vegetation in the source region of the Yellow River generally exhibited an increasing trend, with 92.7% of the area showed improvement, while only 7.3% experienced degradation. The greatest vegetation increase occurred in areas with elevations of 3250–3750 m, whereas vegetation decline was mainly concentrated in regions with elevations of 5250–6250 m. (2) Seasonal differences in vegetation trends were observed, with significant increases in spring, summer, and winter, and a non-significant decrease in autumn. Vegetation degradation in summer and autumn remains a concern, primarily in southeastern and lower-elevation areas, affecting 25% and 27% of the total area, respectively. The maximum annual average NDVI was 0.70, occurring in 2018, while the minimum value was 0.59, observed in 2003. (3) Strong correlations were observed between vegetation dynamics and climatic variables, with temperature and precipitation showing significant positive correlations with vegetation (r = 0.66 and 0.60, respectively; p < 0.01, t-test), suggesting that increases in temperature and precipitation serve as primary drivers for vegetation improvement. (4) Anthropogenic factors, particularly overgrazing and rapid population growth (both human and livestock), were identified as major contributors to the degradation of low-altitude alpine grasslands during summer and autumn periods, with notable impacts observed in counties with higher livestock density and population growth, indicating that for each unit increase in population trend, the NDVI trend decreases by an average of 0.0001. The findings of this research are expected to inform the design and implementation of targeted ecological conservation and restoration strategies in the source region of the Yellow River, such as optimizing land-use planning, guiding reforestation and grassland management efforts, and establishing region-specific policies to mitigate the impacts of climate change and human activities on vegetation ecosystems.