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This usually presents with ataxia or paraesthesia Subacute combined degeneration of the cord Psychiatric Altered mental state such as confusion, memory problems Cognitive changes such as dementia Loss of mental and physical drive Psychiatric disturbances, ranging from mild neurosis to severe dementia Other Angular cheilosis Anosmia, glossitis, and loss of taste Autonomic complications such as postural hypotension Gait problems consider if history of falls Infertility Investigation of possible malabsorptive process Urinary or faecal incontinence Interpreting investigation results Serum cobalamin The clinical normal level of serum cobalamin is unclear

NNMT methylates nicotinamide (a form of vitamin B3) using S-adenosylmethionine (SAM) as the methyl donor

Theyre especially helpful for people who experience sluggish metabolism, hormonal changes, or stubborn fat that doesnt respond to diet and exercise

Lidocaine and ascorbic acid (vitamin C) are also added for their anesthetic and antioxidant properties, respectively