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Dog visits are popular in nursing homes, but we lack knowledge of how dog visits affect nursing home residents. In the present study, we compared immediate response of nursing home residents to dog visits with or without an activity, and impact of cognitive ability and general condition. We randomly assigned 186 nursing home residents to 12 bi-weekly 10-minute visits; either ordinary dog visits (D); dog visits with an activity (DA); or visits without a dog, but with an activity (A). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and/or persons. Data were analysed in three periods of four visits, as either binomial variables or durations. Both visit type and impairment level affected likelihood of interacting with the dog (D and DA). Increased cognitive impairment lowered the odds of touching the dog (period 1, P < 0.05) and talking to it directly (period 1 and 3, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A visits (P = 0.01-0.05), and level of cognitive impairment correlated negatively with duration of talking (P < 0.001). Independently of visit type, high cognitive impairment level lowered the odds of both interacting and talking about the activities (P < 0.01). In conclusion, nursing home residents’ immediate responses to visits depend on both visit type and cognitive impairment. Visits without activity stimulate residents to interact with the dog, but increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired nursing home residents could include a possibility to interact with the dog in different ways, whereas for residents with severe impairment just being with the dog seems more appropriate.