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High-Risk Profiles The threshold for testing should be lower if the individual falls into any of these categories: Age 60 or older Long-term use of metformin or proton pump inhibitors (PPIs) Strict vegetarian or vegan diet Family history of pernicious anemia or autoimmune disease Key Clinical Symptoms Neurological and cognitive: tingling, numbness, or a "pins and needles" sensation in the hands or feet

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Statements Author contributions AR and JA contributed to the organization and design of the manuscript, performed literature reviews, participated in drafting sections of the manuscript, and in revising, reading, and approving the final submitted version

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Chronic conditions present a different challenge