Paired-stimulus preference assessments have been used effectively with individuals with dementia to identify stimuli to increase engagement and to minimize negative affect and problem behavior. We evaluated whether a multiple-stimulus without replacement preference assessment could be used with older adults with dementia and whether preferences remained stable over time. Seven participants completed preference assessments and confirmatory engagement analyses every few weeks for 3 to 5 months; 1 participant failed to complete any preference assessments. Five of the 7 remaining participants displayed higher levels of engagement with the highest ranked stimuli than with the lowest ranked stimuli, confirming the hierarchy in the preference assessment. For the other 2 participants, lowest ranked items resulted in higher levels of engagement than the highest ranked items. Four participants exhibited stable patterns of preference over 3 to 5 months with correlation coefficients exceeding r = .5, suggesting that preferences may remain stable for some individuals with dementia.