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[1] Symptoms of B12 deficiency develop gradually and may include: Persistent fatigue and weakness Neurological symptoms such as paraesthesia (pins and needles), particularly in hands and feet Cognitive changes including memory problems or confusion Glossitis (sore, red tongue) and mouth ulcers Mood disturbances including depression or irritability Balance problems and difficulty walking Neurological complications can become irreversible if left untreated , making prompt diagnosis and treatment essential