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Deficiencies can present with megaloblastic anemia, GI symptoms, neuropsychiatric symptoms, and adverse pregnancy complications, including neural tube defects

T.MbiusW.WinklerA.RuhwedelT.WrzosC.RomanelliE.et al (2016)

Following the MoCA guidelines, we used a cut-off score of 26/30 points to determine mild cognitive impairment.18 For further assessment of potential visuospatial impairment, we also tested the recognition of three additional diagnostic images: the Navon figure, the cookie theft picture from the Boston Diagnostic Aphasia Examination, and the Poppelreuter figure.20212223 These are considered to be standard tools for the assessment of visuospatial cognitive capabilities

Any temperature excursion above 10C for more than 2 hours compromises peptide stability