运动-认知双任务训练对帕金森病患者认知功能的Meta分析

doi:10.3969/j.issn.1006-9771.2025.12.002

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (12): 1376-1384.doi: 10.3969/j.issn.1006-9771.2025.12.002

• 专题　运动干预在康复中的应用 • 上一篇下一篇

运动-认知双任务训练对帕金森病患者认知功能的Meta分析

朱艾荣¹^,², 刘培豪², 郭晶², 管婷玉¹^,², 陈玺竹¹^,², 蔡诗凝¹, 胡雁², 张玉侠¹()

1.复旦大学附属中山医院护理部，上海市 200032
2.复旦大学护理学院，上海市 200032

收稿日期:2025-06-17 修回日期:2025-09-23 出版日期:2025-12-25 发布日期:2025-12-29
通讯作者: 张玉侠 E-mail:zhang.yuxia@zs-hospital.sh.cn
作者简介:朱艾荣(2002-)，男，汉族，福建福州市人，硕士研究生，主要研究方向：老年认知护理、康复护理。
基金资助:
上海市加强公共卫生体系建设三年行动计划(2023-2025年)项目(GWVI-11.1-46)

Motor-cognitive dual-task training for cognitive function in patients with Parkinson's disease: a meta-analysis

ZHU Airong¹^,², LIU Peihao², GUO Jing², GUAN Tingyu¹^,², CHEN Xizhu¹^,², CAI Shining¹, HU Yan², ZHANG Yuxia¹()

1. Nursing Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China
2. School of Nursing, Fudan University, Shanghai 200032, China

Received:2025-06-17 Revised:2025-09-23 Published:2025-12-25 Online:2025-12-29
Contact: ZHANG Yuxia E-mail:zhang.yuxia@zs-hospital.sh.cn
Supported by:
Shanghai Public Health System Construction Three-Year Action Plan (2023-2025)(GWVI-11.1-46)

摘要/Abstract

摘要：

目的探讨运动联合认知双任务训练对帕金森病患者认知功能的效果。
方法遵循PRISMA指南，系统检索Cochrane Library、Web of Science、Embase、PubMed、中国知网、万方数据库、维普和中国生物医学文献数据库中关于运动联合认知双任务训练对帕金森病患者认知功能影响的随机对照试验(RCT)，检索时限为建库至2024年12月20日。采用Cochrane评价手册5.1.0版RCT偏倚风险评估工具和PEDro量表对纳入文献进行质量评价。采用RevMan 5.4进行Meta分析。采用GRADE进行证据质量评价。
结果共纳入10篇文献，涉及330例患者，PEDro量表评分6~9分。Meta分析结果显示，运动联合认知双任务训练能改善帕金森病患者的蒙特利尔认知评估(MoCA)评分(MD = 2.05, 95%CI 0.38~3.73, P = 0.02)；Stroop色词测试(SCWT)反应时和正确数、连线测试A (TMT-A)、连线测试B (TMT-B)均与对照组无显著性差异(P > 0.05)。亚组分析显示，干预时长≥ 3个月时，MoCA改善效应显著优于对照组(MD = 3.64, 95%CI 3.13~4.16, P < 0.001)。双任务训练改善MoCA的GRADE为低级，改善TMT-A、TMT-B、SCWT反应时和正确数为中级。
结论运动联合认知双任务训练能改善帕金森病患者整体认知功能，推荐进行≥ 3个月的干预；对视空间和执行功能的效果有待进一步研究。

关键词: 帕金森病, 认知, 运动, 双任务, 认知功能, Meta分析

Abstract:

Objective To explore the effect of motor-cognitive dual-task training on cognitive function in patients with Parkinson's disease (PD).
Methods Following the PRISMA guidelines, randomized controlled trials (RCT) evaluating the effect of motor-cognitive dual-task training on cognitive function in PD patients were systematically searched in the Cochrane Library, Web of Science, Embase, PubMed, CNKI, Wanfang data, VIP and Chinese Biomedical Literature Database from inception to December 20, 2024. The methodological quality of the included studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 risk-of-bias tool and the PEDro scale. Meta-analysis was conducted using RevMan 5.4, and GRADE approach was applied to evaluate the quality of evidence.
Result A total of ten studies involving 330 patients were included, with PEDro scores ranging from six to nine. Meta-analysis showed that motor-cognitive dual-task training significantly improved Montreal Cognitive Assessment (MoCA) scores (MD = 2.05, 95%CI 0.38 to 3.73, P = 0.02). There was no difference in Stroop Color and Word Test (SCWT) (reaction time and accuracy), Trail Making Test A (TMT-A) and Trail Making Test B (TMT-B) from the control group (P > 0.05). Subgroup analysis indicated that interventions lasting more than three months improved the MoCA scores (MD = 3.64, 95%CI 3.13 to 4.16, P < 0.001). The GRADE rating of evidence was low for MoCA improvement, and moderate for improvements in TMT-A, TMT-B, and Stroop Color-Word Test (reaction time and accuracy).
Conclusion Motor-cognitive dual-task training can improve overall cognitive function in patients with PD, as the intervention durations more than three months. The effect on visuospatial and executive function requires further investigation.

Key words: Parkinson's disease, cognition, motor, dual-task, cognitive function, meta-analysis

中图分类号:

R742.5

朱艾荣, 刘培豪, 郭晶, 管婷玉, 陈玺竹, 蔡诗凝, 胡雁, 张玉侠. 运动-认知双任务训练对帕金森病患者认知功能的Meta分析[J]. 《中国康复理论与实践》, 2025, 31(12): 1376-1384.

ZHU Airong, LIU Peihao, GUO Jing, GUAN Tingyu, CHEN Xizhu, CAI Shining, HU Yan, ZHANG Yuxia. Motor-cognitive dual-task training for cognitive function in patients with Parkinson's disease: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(12): 1376-1384.

图/表 9

表1

图1

图2

图3

表2

表3

纳入文献基本特征"

纳入文献	国家	年龄(试验组/对照组)/岁	n(对照组/试验组)	Hoehn-Yahr分期	对照组干预措施	试验组干预措施	干预时间、频率、周期	结局指标	评价工具
Pompeu等^[23](2012)	巴西	68.6±8.0/66.2±8.3	16/16	1~2	常规平衡训练	游戏化双任务：基于Wii设备的平衡/步态结合认知训练	每次60 min，每周2次，共7周	认知功能	①
Pohl等^[24](2013)	瑞典		6/12	1~4	常规康复训练	音乐节律双任务：节律结合音符认知训练	每次60 min，每周2次，共6周	执行功能	②
Fernandes等^[25](2015)	葡萄牙	62.3±12.9/63.4±9.5	7/8	1~3	与试验组相同的平衡训练	平衡认知双任务：稳定性/步行训练同时记忆/命名/拼写	每次60 min，每周2次，共6周	视空间能力、注意力及工作记忆	③④
San Martín Valenzuela等^[26](2020)	西班牙	64.8±8.8/66.4±7.1	17/23	1~3	与试验组相同的平衡训练	平衡认知双任务：步行训练同时记忆/时间读取/声音识别	每次60 min，每周2次，共10周	视空间能力、注意力及工作记忆	③④
Park等^[27](2021)	韩国	63.1±10.1/61.6±4.9	6/6	2~3	常规康复训练	音乐节律双任务：节律演奏同时唱歌/任务切换	每次50 min，每周3次，共12周	视空间能力、注意力及工作记忆	⑤⑥
林玲等^[28](2022)	中国	71.8±5.4/73.7±3.1	20/20	1~2.5	常规平衡训练	平衡认知双任务：步行训练同时计算/记忆/命名	每次30 min，每周3次，共12周	认知功能	①
Pereira-Pedro等^[29](2022)	西班牙	65.4±5.2/70.5±9.2	7/8	2~3	与试验组相同的骑行训练	骑行认知双任务：骑行同时词语/句子排序	每次20 min，每周2次，共7周	执行功能	②
Jäggi等^[30](2023)	瑞士	72.9±10.1/71.9±9.1	21/19	1~4	常规康复训练	游戏化双任务：基于Davidat设备的步伐结合认知训练	每次15 min，每周5次，共2~4周	执行功能、视空间能力、注意力及工作记忆	②③④
陈德芳等^[31](2024)	中国	70.2±6.3/71.4±6.9	45/45	1~2.5	常规康复训练	平衡认知双任务：体操/步行同时计算/命名/记忆	每次30 min，每周3次，共24周	认知功能	①
Zhou等^[32](2024)	中国	63.1±9.4/62.3±5.4	14/14	1~3	与试验组相同的平衡训练	平衡认知双任务：跑台行走同时回忆/计算/命名	每次90 min，每周2次，共8周	认知功能；执行功能、视空间能力、注意力及工作记忆	①②③④

表3

表4

表5

表6

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人群(Population)	干预(Intervention)	比较(Comparison)	结局(Outcome)
PD患者	干预场所医院社区康复中心	运动联合认知双任务训练干预与常规康复训练或认知训练的比较	身体功能 b140注意力功能 b156知觉功能 b164高水平认知功能
	干预措施
	同时进行的运动联合认知训练
	干预人员
	康复治疗师
	干预疗程

纳入文献	明确的纳入排除标准	随机分配	分配隐藏	基线相似	研究对象施盲	治疗师施盲	结果评估施盲	退出率< 15%	意向治疗分析	组间统计结果分析	点测量和差异值	总分
Pompeu等^[23](2012)	√	√	√	√			√	√	√	√	√	8
Pohl等^[24](2013)	√	√	√	√			√	√		√	√	7
Fernandes等^[25](2015)	√	√		√	√		√	√		√	√	7
San Martín Valenzuela等^[26](2020)	√	√	√	√			√	√		√	√	7
Park等^[27](2021)	√	√	√	√			√	√		√	√	7
林玲等^[28](2022)	√			√			√	√	√	√	√	6
Pereira-Pedro等^[29](2022)	√	√	√	√	√	√	√	√		√	√	9
Jäggi等^[30](2023)	√	√	√	√				√		√	√	6
陈德芳等^[31](2024)	√			√			√	√	√	√	√	6
Zhou等^[32](2024)	√	√		√			√	√	√	√	√	7

结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²值	P值	效应模型	MD/SMD(95%CI)	P值
MoCA评分	4^{[23,28,31-32]}	89	< 0.001	随机效应模型	2.05(0.38, 3.73)	0.02
TMT-A评分	5^{[25-27,30,32]}	0	0.98	固定效应模型	-0.30(-0.64, 0.04)	0.09
TMT-B评分	5^{[25-27,30,32]}	0	0.86	固定效应模型	-0.20(-0.55, 0.14)	0.24
SCWT反应时	2^[24,30]	0	0.79	固定效应模型	-2.23(-12.88, 8.42)	0.68
SCWT正确数	2^[29,32]	0	0.96	固定效应模型	4.02(-2.79, 10.84)	0.25

干预时长	纳入研究数/n	样本量/n	异质性检验		效应模型	Meta分析结果
干预时长	纳入研究数/n	样本量/n	I²值	P值	效应模型	MD(95%CI)	P值
< 3个月	2	30	0	0.94	固定效应模型	0.24(-0.98, 1.46)	0.700
≥ 3个月	2	65	0	0.33	固定效应模型	3.64(3.13, 4.16)	< 0.001

结局指标	研究数量/n	样本量/n	不一致性	不准确性	证据等级
MoCA评分	4^{[23,28,31-32]}	190	降一级^a	降一级^b	低
TMT-A评分	5^{[25-27,30,32]}	135	0	降一级^b	中等
TMT-B评分	5^{[25-27,30,32]}	135	0	降一级^b	中等
SCWT反应时	2^[24,30]	58	0	降一级^b	中等
SCWT正确数	2^[29,32]	43	0	降一级^b	中等

运动-认知双任务训练对帕金森病患者认知功能的Meta分析

Motor-cognitive dual-task training for cognitive function in patients with Parkinson's disease: a meta-analysis

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