Individuals with dementia suffer from a variety of cognitive deficits that can lead to a lack of engagement in activities. In recent years, researchers have begun to look at ways to assess preferences in hopes that increased identification of leisure items may lead to increases in engagement. Due to the decline in cognitive status a simple questionnaire may not be sufficient to assess preference for this population. As a result, several recent studies have incorporated the use of systematic preference assessments to assess preference for leisure activities with adults with dementia using a paired stimulus format. The purpose of the current study was to assess the predictive validity of a more time-efficient assessment, the MSWO assessment, for older adults with dementia. In addition, the current study assessed the stability of preferences of individuals diagnosed with dementia by administering repeated MSWO assessments. Eleven adults with dementia experienced MSWO preference assessments and 7 of those participants experienced additional administrations of the MSWO assessment over a span of 3 to 5 months to examine the stability of preferences. Engagement analyses were conducted to determine if the items ranked highly in the MSWO assessments also obtained higher levels of engagement than lower-ranked selections. Ten of the 11 participants diagnosed with dementia completed the first MSWO assessment and a confirmatory engagement analyses. Six of these 10 participants displayed higher levels of engagement for higher ranked stimuli than for lower ranked stimuli. For the remaining 4 participants, results indicated that little to no differentiation occurred between high-ranked and mid to low-ranked items. Five of the 7 participants that experienced repeated MSWO assessments exhibited stable patterns of preference over 3 to 5 months with correlation coefficients exceeding the critical value of .5. These findings suggest that preference may remain stable for individuals with dementia.