Abstract: Objective　To evaluate the effects of cognitive therapy combined with physical exercise on elderly patients with dementia and mild cognitive impairment（MCI）．Methods　A systematic search of electronic databases，including Cochrane Library，PubMed，EBSCO，CINAHL，EMBase，CMB，CNKI，Wanfang and VIP Database were conducted on May，2018.All randomized controlled trials（RCTs） on cognitive therapy combined with physical exercise intervention for the elderly with Alzheimer's disease were identified.Two reviewers independently screened abstracts，extracted data and evaluated the quality of articles.Meta analysis of cognitive function，daily living ability，depression level，executive function，memory and attention，and laboratory examination was performed by using RevMan 5.0 software.Results　Thirteen trials with a total of 812 subjects were finally included.The results of Meta-analysis showed that the mini-mental state examination（MMSE） score of treatment group was higher than that of control group 〔MD=0.73，95%CI（0.09，1.38），P=0.03〕；the Alzheimer's Disease Assessment Scale-Cognitive section（ADAS-COG） score of MCI patients in treatment group was lower than that of control group 〔MD=-1.30，95%CI（-1.65，-0.95），P < 0.000 01〕；there was no significant difference in ADAS-COG score of AD patients between two groups 〔MD=-0.32，95%CI（-0.69，0.05），P=0.09〕；the score of daily living ability in treatment group was higher than that in control group 〔SMD=0.43，95%CI（0.02，0.85），P=0.04〕；the depression level in treatment group was lower than that in control group 〔SMD=-0.85，95%CI（-1.37，-0.34），P=0.001〕；verbal fluency in treatment group was higher than that in control group 〔SMD=0.81，95%CI（0.38，1.24），P=0.000 2〕.The independent standing and balance ability，disease influence degree，memory and attention，and laboratory examination in treatment group were improved compared to those in treatment group.Conclusion　The cognitive therapy combined with physical exercise offers an effective and economical means to improve general function of elderly patients.

Key words: Cognitive therapy, Exercise therapy, Alzheimer disease, Mild cognitive impairment, Meta-analysis

摘要： 目的　采用Meta分析评价认知联合运动疗法干预阿尔茨海默病（AD）与轻度认知障碍（MCI）老年人的效果。方法　计算机检索Cochrane图书馆、PubMed、EBSCO、CINAHL、EMBase、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网，检索时间为建库至2018年5月，收集关于采用认知联合运动疗法治疗AD与MCI的随机对照试验，对纳入文献进行质量评价和数据提取，采用RevMan 5.0软件对认知功能水平、日常生活能力、抑郁水平、执行功能、记忆力与注意力、实验室检查进行Meta分析。结果　共纳入13篇文献，共812例患者。Meta分析结果显示，治疗组简易精神状态检查量表（MMSE）评分高于对照组〔加权均数差（MD）=0.73，95%CI（0.09，1.38），P=0.03〕；治疗组MCI患者的阿尔茨海默病认知量表（ADAS-COG）评分低于对照组〔MD=-1.30，95%CI（-1.65，-0.95），P<0.000 01〕；两组AD患者的ADAS-COG评分比较，差异无统计学意义〔MD=-0.32，95%CI（-0.69，0.05），P=0.09〕；治疗组日常生活能力评分高于对照组〔标准化均数差（SMD）=0.43，95%CI（0.02，0.85），P=0.04〕；治疗组抑郁水平低于对照组〔SMD=-0.85，95%CI（-1.37，-0.34），P=0.001〕；治疗组言语流利性高于对照组〔SMD=0.81，95%CI（0.38，1.24），P=0.000 2〕；治疗组的独立站立与平衡能力、疾病影响程度、记忆力与注意力、实验室检查与对照组比较均有所改善。结论　认知联合运动疗法简便易廉，安全性较好，可有效改善患者的整体功能水平。

关键词: 认知疗法, 运动疗法, 阿尔茨海默病, 轻度认知障碍, Meta分析