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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

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