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A 2024 systematic review published in a peer-reviewed orthopaedic journal acknowledged these findings while flagging a critical limitation: there are no completed Phase III clinical trials in humans

Certain genetic disorders can cause true neurodegenerative dementia in younger populations (e.g

[DOI] [PMC free article] [PubMed] [Google Scholar] 231.Ishibashi T., Murata T., Hangai M., Nagai R., Horiuchi S., Lopez P.F., Hinton D.R., Ryan S.J

They found that 9% had an outright deficiency and 16% exhibited a near deficiency. Many of these individuals were suffering from neurological symptoms (4)

My rule of thumb is if the latest and most current B12 result is above the defined acceptable range then it is advisable to recommend a reduction in the frequency of the intervention