Although estimates place the prevalence of dementia in nursing home residents at approximately 50%, the longitudinal course of cognition and cognitive impairment in nursing home residents are not well understood. Using data from 33 long-term care residents, patterns of performance on the Mini-Mental State Examination across multiple quarterly administrations were examined. Results show that four distinct patterns were evident: declining, stable, improving, and inconsistent performance. Although a number of residents exhibited declines in performance across multiple administrations, the performance of the majority of residents either remained stable or improved. Few clinical correlates of patterns of performance were observed in this cohort. These results have implications for providers working in nursing homes and raise important questions for future research. Copyright © Taylor & Francis Group, LLC.