the prevalence of alzheimer s disease or senile dementia , in citizens over 65  years old has 
 been implicated to increase from 8.8% in 2010 to 9.7% in 2020 , 11.2% in 2040 , and 13.2% in 
 20501 . currently , the understanding of 
 dementia is increasing , and therapies and interventions are being developed . the concept of 
 milieu therapy for dementia through therapeutic activities and activity therapy is 
 increasingly gaining interest . activity therapy , which can reduce the degeneration rate of 
 cognitive function , which is a characteristic symptom of dementia , is being attempted , and 
 its effectiveness has been reported . regular exercise for a patient with dementia is an 
 essential factor and an effective strategy to delay the onset of dementia2 . for the demented elderly , exercise was reported to not only be effective in reducing the 
 fall risk by improving brain activation , increasing brain blood flow and neurotransmitter 
 secretion , and enhancing muscle flexibility and the sense of balance , but also in enabling 
 smooth gastrointestinal motility , increasing joint motion range by increasing physical 
 strength , and providing an anti - depressant effect3 . in addition , exercise can reduce the early - onset rate of stroke and adult diseases such as 
 hypertension , diabetes , hyperlipidemia , and obesity , which cause dementia , thus preventing 
 dementia progression or delaying disease initiation . further , exercise is known to prevent 
 mental and physical malfunction , improving confidence and a sense of accomplishment in 
 patients4 , 5 . in particular , regular exercise results in improvements in 
 cognitive function , as indicated by the reduced loss of frontal and temporal node tissue 
 when the brain volume was measured using the magnetic resonance imaging6 . however , there is still a lack of direct research on how 
 activities for health promotion change electroencephalogram ( eeg ) findings in the demented 
 elderly . if a recreation program is provided for treatment and rehabilitation , it may enhance the 
 life quality by changing eeg findings of the demented elderly . therefore , the purpose of this study was to investigate how participation in a recreation 
 program influences changes in eeg findings in the demented elderly . subjects included male and female patients over 65  years old at a dementia nursing center 
 and a municipal geriatric hospital . for the final analysis , 14 patients were included in the 
 experimental group and 18 in the control group . before the study , the purpose and process these subjects had 
 no regular exercise habits and walked independently , and scored 1123 points on the 
 mini - mental state examination , were diagnosed as the first and mid - term dementia , and thus 
 had no apraxia and could communicate . to empirically verify the changes in eegs of the demented elderly for depression , sleep 
 disorder , and life quality during their participation in the therapeutic recreation program , 
 the subjects were classified into the experimental group that attended therapeutic 
 recreation programs regularly for 3 months , and the control group that did not attended any 
 therapeutic recreation programs . owing to the characteristics of on - site research , the 
 experimental and control groups could not be divided evenly , and exact matching of 
 background variables between groups was impractical ; therefore , the non - equivalent control 
 group design , which is a quasi - experimental design method , was applied . the eeg test : the 2-channel wired eeg monitor ( lxe 3202 ; cans 3000 , laxtha inc . ) and 
 telescan , a data acquisition and analysis software , were used to measure eeg ( sp ) and erp 
 ( ep ) , respectively . to measure changes in eegs and to analyze the brain functions , balance 
 index , attention index , emotion index , anti - stress index , and brain quotient ( bq ) amusement , social activity , and habit - cultural activity were selected , as 
 the main focus of health - sports activities , to match the health of the demented elderly , and 
 indoor environment activities were selected by referring to the classification criteria , 
 such as leisure education , cooking activity , outdoor activity , hobby , etc . ( table 1table 1.the protocol in the therapeutic recreation programsteptypedayprogramintroductionsocial activity1massage2game3sing a songdevelopmenthealth - sports activities49yoga game10music and dance111214sing a song and rec - dance15mini sports16habit - cultural activities17korean music1819paper art2021magic22read a bookclosingevaluation23recreation24 ) . these were reconstructed by jeong7 in reference to the models regarding amusement , social activity , 
 hobby - cultural activity , watching - viewing activity , health - sports activity , and tour 
 activity , as classified by choi8 and the 
 leisure education programs , as suggested by the leisure - related document9 . the therapeutic recreation program is 
 implemented for 40 minutes , 2 times per week for 3 months , and is composed of 3 stages : 
 introduction , development , and closing / evaluation . all experiments were reviewed and 
 approved by the committee of the chungnam national university . the pre - intervention and 
 post - intervention data were examined using the paired t - test within each group of subjects 
 and the independent t - test between the groups . in order to compare changes in eeg between the experimental and controls groups , the pre- 
 and post - program eeg values were measured , the average and the standard deviation were 
 calculated for each group , and the differences in eeg values between the two groups were 
 analyzed . table 2table 2.changes in eeg values between groupseegsgrouppre - testpost - testbalance indexe71.2 ( 2.1)74.6 ( 1.0)c70.7 ( 6.3)71.6 ( 1.8)emotion indexe54.3 ( 4.6)59.9 ( 4.3)c55.5 ( 2.4)56.3 ( 3.4)attention indexe46.1 ( 3.2)48.1 ( 4.2)c44.3 ( 1.4)45.8 ( 4.0)anti - stress index.e56.7 ( 3.0)60.1 ( 4.6)*c54.2 ( 3.5)55.1 ( 3.6)brain quotiente52.6 ( 1.2)55.3 ( 2.7)*c50.4 ( 2.3)51.1 ( 4.0)experimental group + control group , mean  sd , * : p<0.05 shows the average and the standard deviation values between the pre- and 
 post - program eeg values for each group , as well as differences in the values between 
 groups . experimental group + control group , mean  sd , * : p<0.05 table 2 displays the average pre- and 
 post - program eeg values for each group . the differences in pre - program eeg values in the 
 experimental group were minor , but those in post - program eeg values between groups were 
 greater . in brief , eeg values were higher in the experimental group than in the control 
 group , demonstrating that participation in a therapeutic recreation program enhances eeg 
 values . however , minor differences in post - program eeg values were noted for all variables 
 between the two groups , except for the anti - stress index and bq . first , the balance index of patients with dementia showed significant patterns in the 
 left - right asymmetry compared to that in the normal control group , as determined using the 
 spatio - temporal pattern analysis10 , and 
 the corpus callosum , which transmits information between the left and the right hemispheres , 
 became atrophied11 , and the hemispheric 
 disconnection syndrome could be explained . a normal brain is the one showing balance between the left and right sides , which means 
 that there must be mutual interchange through the corpus callosum , thus providing stability 
 in emotional inclination . therefore , in this study , the left - right hemispheric balance index 
 displayed more changes after the experiment compared to that before the experiment , implying 
 partial brain activation . second , bryant and veroff12 analyzed mental health in the social and historical context and 
 found that the mental health structure can be positive or negative , and that  positive 
 mental health is the psychological wellbeing and is composed of positive emotion and 
 emotional relation  , and  negative mental health is psychological stress and is made up of 
 anxiety , depression , and emotional loss of control  . chung13 compared the estimated values of 
 self - reported emotion , motif , and positive personality traits in each frontal lobe by 
 activation groups , and found that the relative left activation group showed a significantly 
 higher level of positive affect , approach motivation , happiness , hope , and ego - resiliency 
 than the relative right activation group . moreover , for the personal affect type , the 
 relative activation of the frontal cortex has relations with positive affect with respect to 
 the left side14 . this study confirmed that the therapeutic recreation program enabled changes in brain 
 activation and revealed the relation between the activity program and emotion via the 
 anti - stress index . third , the study on eeg changes with respect to attention and concentration following the 
 yoga program by exercise intensity showed that absolute and relative alpha waves emitted 
 during concentration or creative thinking decreased , consequently increasing attention and 
 concentration . in this study , the appropriate intensity of exercise implemented through therapeutic 
 recreation enabled creative thinking in the elderly , thus increasing their attention 
 concentration . fourth , catecholamine , one of the stress hormones , is not essential for life support , but 
 is released rapidly when during stress conditions . many studies have used surveys to measure cognitive function through motion stimulus in 
 elderly patients with alzheimer s disease , but these previous studies on the approach of 
 brain function are from the viewpoint of physiology . nevertheless , the study on the effect 
 of resistance training on the brain function index in the elderly with alzheimer s 
 disease16 , 17 demonstrated that the brain index increased after exercise both in 
 the resistance training and gymnastics groups , thus supporting this study result .
[ purpose ] this study investigated how participation in a recreation program influences 
 electroencephalogram changes in the demented elderly . [ subjects ] fourteen patients were 
 included in the experimental group and 18 in the control group . 
 [ methods ] they had no 
 regular exercise habits , and walked independently , and scored 1123 points on the 
 mini - mental state examination , and thus had no apraxia and could communicate . to 
 empirically verify changes in electroencephalograms of the demented elderly for 
 depression , sleep disorder , and life quality through their participation in the 
 therapeutic recreation program , male and female citizens > 65  years old at a geriatric 
 hospital were included . 
 the experimental group attended therapeutic recreation programs 
 regularly for 3 months and control group did not . 
 [ results ] electroencephalogram values 
 were higher in the experimental than in the control group , demonstrating that the 
 therapeutic recreation program enhances electroencephalogram values . however , post - program 
 electroencephalograms between the two groups showed minor differences for all variables , 
 except for the anti - stress index and brain quotient . 
 [ conclusion ] the therapeutic 
 recreation program caused changes in brain activation , and this method revealed the 
 relation between the activity program and emotion via the anti - stress index .