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Systemic infections including Epstein-Barr virus (infectious mononucleosis), cytomegalovirus, toxoplasmosis, HIV, tuberculosis, cat scratch disease (Bartonella), and certain sexually transmitted infections should be considered based on clinical context and risk factors

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In neuronal senescence model studies, the active ingredient of the product can cross the blood-brain barrier (and act directly on neurons in vitro), increase NAD+ levels in nerve cells, protect mitochondrial function, reduce neuronal apoptosis, and promote the synthesis and release of neurotransmitters (such as dopamine and acetylcholine), thereby improving signal transduction in nerve cells

There are also foods fortified (supplemented) with B12 including breakfast cereals, nutritional yeast and infant formulas