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(14) The committee recommended that vitamin B12 be performed in the initial work-up for those with suspected mild cognitive impairment or dementia, but added the caveat, Current data from systematic reviews of randomized double blind trials, however, do not provide evidence of improvement in cognition or dementia with B12 treatment. Ontario Context In fiscal year 2010/2011, more than 2.9 million serum vitamin B12 laboratory tests were billed to the province at a cost of approximately $40 million

Elevated homocysteine has been linked to increased oxidative stress and poorer blood vessel function, which can worsen cognitive decline

The proposed chain of effects looks like this: NNMT inhibited nicotinamide is no longer inactivated by methylation and becomes available for conversion to NAD+

Phase 2b doses were 0.25 to 1.0 mg daily, which at a 2.5 mg/ml concentration means 0.1 to 0.4 ml per injection, conveniently measurable on a 1 ml insulin syringe