Vitamin B12 deficiency is common in older adults and predisposed to by several factors including inadequate diet, food-cobalamin malabsorption, a host of gastric and small intestinal disorders, and medications. The presentations of B12 deficiency range from the asymptomatic to hematological, neuropsychiatric, and other manifestations. Screening may be directed to those at risk and with suggestive clinical features. Diagnosis of B12 deficiency is easy and treatment is inexpensive. While hematological manifestations are reversible, neurological complications have a short window of opportunity for correction, emphasizing the importance of early diagnosis. Folate deficiency is also common in older adults and predisposed by dietary preferences or restrictions. Folate deficiency causes reversible hematological features similar to B12 deficiency, without the neurological manifestations. Folate deficiency has been linked to cognitive impairment and depression. Monitoring folate levels following supplementation is the preferred approach, rather than checking homocysteine levels.
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