From 27 studies with 2,334 samples and 19 natural extract treatments, RPTW showed the greatest improvement in overall cognition (SUCRA: 95.9%). No extracts significantly outperformed placebo for attention. CG (Cistanche + Ginkgo biloba) was most effective for memory (SUCRA: 89.3%), executive function (SUCRA: 96.9%), and cognitive flexibility (SUCRA: 98.0%).