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It typically presents as macrocytic megaloblastic anemia and neurological impairments, including sensory and motor disfunctions, predominantly in the lower extremities, ataxia, and in more advanced stages cognitive decline progressing to dementia, as well as psychiatric disturbances (Green et al., 2017)

Supporting MTHFR often improves COMT Both handle neurotransmitters

Wang et al., 2012)

This is because the serum MMA can be an indicator of metabolic change that is highly specific to a B12 deficiency