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Symptoms include: Peripheral neuropathy: Numbness, tingling, or burning sensations in the hands and feet Subacute combined degeneration of the spinal cord: Loss of balance, difficulty walking, weakness, and spasticity Cognitive impairment: Memory loss, confusion, and dementia Psychiatric symptoms: Depression, irritability, and personality changes Visual disturbances: Blurred or double vision Other Manifestations: Gastrointestinal symptoms: Sore tongue (glossitis), loss of appetite, nausea, vomiting, and diarrhea Dermatologic changes: Hyperpigmentation of the skin, vitiligo, and hair changes Note: The clinical presentation can vary depending on the severity and duration of the deficiency

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