Background/Aim: Hand movement observation activates mirror neurons, located in brain areas that are vulnerable to Alzheimer's disease. We examined the effects of hand movement observation on cognition in older persons with dementia. Methods: Nursing home residents with dementia (n = 44) watched either videos showing hand movements or videos showing a documentary for 30 min, 5 days a week, for 6 weeks. Neuropsychological tests were performed at baseline, week 6 and week 12. Results: Linear mixed model analyses revealed a significant interaction effect on an attention test, but not on cognitive domains. Additional analyses showed that a face recognition task improved significantly. Conclusion: Although these findings do not support an overall beneficial effect of hand movement observation on cognition in dementia, specific cognitive functions improved. Future studies are warranted. © 2009 S. Karger AG, Basel.