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Patients should be referred urgently if they have neurological symptoms, if the diagnosis is unclear, or if there is inadequate clinical response to treatment
+ B12 injections suit vegetarians and vegans who do not eat animal foods, patients with confirmed absorption issues such as pernicious anaemia, coeliac disease or significant IBS, older adults whose stomach acid has dropped with age, and patients on long-term metformin or proton-pump inhibitors that lower B12 absorption
1: Spaghetti plots of intra-patient differences in primary and secondary efficacy outcomes from oral l-dopa treatment to A-dopamine treatment
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