Regardless of age, people take note when they realize they’re regularly forgetting where they left their keys. As a person ages, forgetfulness triggers thoughts and concerns of dementia issues. According to the Alzheimer’s Association, Alzheimer’s disease is the most common form of dementia, causing memory problems and issues with thinking and behavior.

Before jumping to conclusions about memory concerns, it’s prudent to check whether those issues could be related to nutrient deficiencies. For the brain to fully function, it requires adequate amounts of multiple nutrients. Research shows that blood values of vitamins A, C, E, folate and especially vitamin B12 are significantly lower in those with Alzheimer’s disease. Inadequate amounts of any of these vitamins can result in some of the same symptoms as mild dementia.

Symptoms of B12 deficiency and early Alzheimer’s share issues of short-term memory, misplacing items, forgetting recent conversations or activities, and commenting or asking the same question repeatedly. Other shared symptoms include disturbed sleep, mood swings, depression, increased frustration, agitation and anxiety. Occurrences of tripping and dropping things might also increase.

A B12 deficiency often goes unrecognized because the symptoms are highly varied and can occur before blood tests indicate classic B12 anemia or before blood values fall below the diagnostic B12 deficiency level. Because the depletion of B12 in blood might not become evident for five years or more, an older person chronically deficient in B12 can suffer nervous system damage and irreversible memory and behavioral problems.

A more reliable blood test for B12 status indicates the level of blood methylmalonic acid, which increases when B12 is deficient.

B12 deficiency is a common condition affecting older adults and tends to increase with age.

Multiple health issues increase the likelihood of developing a B12 deficiency, including chronic stomach or intestinal problems, hypothyroid conditions, age- related neurodegenerative disorders such as Parkinson’s disease, weight-loss surgery, and states that result in a low iron status such as Helicobacter pylori, frequent blood donations or vegetarian diets. Research also shows that those taking metformin or acid- lowering medications such as proton-pump inhibitors are likely to have a lower B12 level.

The absorption of B12 from plant-based diets and “natural” foods may be limited. Therefore, the Food and Nutrition Board of the Institute of Medicine recommends that adults over age 50 obtain their vitamin B12 mainly as synthetic B12 in fortified foods or by taking B12 supplements.

Add a moderate-dose multivitamin mineral supplement and a 500 mcg sublinqual (placed under the tongue) B12 supplement daily to ensure that you get the nutrients needed for brain health. Sublinqual B12 is safe and is absorbed directly into blood vessels when dissolved under the tongue. Remember, getting all your essential nutrients is the best way to stay young at heart.

Joannie Dobbs, Ph.D., C.N.S., and Alan Titchenal, Ph.D., C.N.S., are retired nutrition faculty from the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa.