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Because the symptoms are often non-specific, they are easy to attribute to other causes

NICE and British Society for Haematology guidelines recommend: Initial treatment with hydroxocobalamin (the preferred form in the UK) via intramuscular injection For patients without neurological involvement: 1 mg IM three times a week for 2 weeks For patients with neurological involvement: 1 mg IM on alternate days until no further improvement Maintenance: 1 mg every 3 months for patients without neurological involvement

Compared to placebo, B-vitamin supplementation in these older subjects also improved a measure of executive function, a secondary outcome of the trial (93)