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The definition of vitamin B12 deficiency varies with the assay used but generally includes serum cobalamin levels below 148 pmol/L plus symptoms, or elevated serum homocysteine, or increased methylmalonic acid (MMA) (74)
doi: 10.1002/ijc.24027
Intranasal administration, though less studied with Dihexa specifically, would theoretically provide the most direct CNS delivery with minimal systemic exposurepotentially requiring even less frequent dosing to maintain effective brain tissue concentrations
Allow 2-4 weeks at each new dose to assess response before further adjustment
In addition, it has been claimed to promote new vessel formation (28), upregulation of the growth factors, as well as influencing other local factors (46, 47)