Background: Physical activity such as walking may exert a positive impact on cognition and behaviour in older persons with dementia, but due to the frailty of the population it may be worthwhile to consider other motor activities as well. Objective: Examining the effects of hand motor activity on cognition, mood and the rest-activity rhythm in older persons with dementia. Methods: Sixty-one older nursing home residents with dementia (mean age 84.6 years) were randomly assigned to either a hand movement program (experimental) or read aloud program (control) for 30 min, 5 days a week, during 6 weeks. Neuropsychological tests, mood questionnaires, and actigraphy data were assessed at baseline, after 6 weeks, and again after 6 weeks. Apolipoprotein epsilon (ApoE) genotype was determined. Results: Scores on neuropsychological tests were combined and formed specific Cognitive domains. Symptoms of depression and anxiety formed the Mood domain. Actigraphy variables composed the Rest-activity domain. In mixed model analyses no significant group × time interactions were found on either the Cognitive, Mood or Rest-activity domains in the intention-to-treat analysis. In the per protocol analysis, that included people who attended at least 80% of the sessions, mood improved only in the experimental group. No significant time × group × ApoE interaction effects were found in either analysis. Conclusion: In older nursing home residents with dementia, increased attendance to the hand movement program appeared to have a positive effect on mood. Hand motor activity is a type of activity that can be applied at a large scale. © 2008 Elsevier B.V. All rights reserved.