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Conclusions: Given the high prevalence of clinical and subclinical vitamin B 12 deficiency in the elderly, the role of vitamin B 12 in myelination, and vitamin B 12 deficiency as a differential diagnosis of DCM, it is important to investigate what role vitamin B 12 levels play in patients with DCM in terms of baseline neurological function and whether optimization of vitamin B 12 levels can improve surgical outcome

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A 500mcg daily protocol under split dosing would look like: 300mcg upon waking (fasted), then 200mcg approximately 30 minutes before dinner or before bed on an empty stomach

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Maintenance and discontinuation SURMOUNT-4, continue vs placebo switch after lead-in to about 20.9% loss: stopping regained about +14% over 52 weeks while continuing lost a further -5.5%