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For people with progressive cognitive and functional decline living in an institution, maintaining the activities that they consider meaningful is a challenge. Identifying these meaningful activities is an important step in developing personalized care. The aim of this study is to describe the meaningful activities of a sample group of this population and observe whether they differ according to the degree of cognitive impairment. We interviewed 203 participants with major neurocognitive disorders living in thirteen nursing homes, dividing them into three sub-groups with moderate, moderately severe, and severe impairment. Each resident was asked to list up to three meaningful activities. These activities were classified into three categories: social activities involving members of the institution, social activities involving family, and non-social activities. On average, participants mentioned 2.55 meaningful activities each. Of these, 56.9% were non-social activities, 34.5% were social activities involving members of the institution, and 8.6% were social activities involving family. The number of significant activities listed by the residents decreased with the severity of cognitive impairment (respectively, 2.79, 2.62, 2.27, p < 0.05). Interestingly, the number of non-social activities decreased with the severity of cognitive impairment (respectively 1.18, 1.57, 1.57, p < 0.05), while the number of social activities (involving either members of the institution or family) was similar across the different stages of cognitive impairment. As cognitive decline progresses, individuals with neurocognitive disorders tend to perceive fewer activities as meaningful. However, among the meaningful activities, social activities remain important, including in severe dementia.