Use the tables below to add up your score and determine your risk of B12 deficiency.

Cobalamin Deficiency Risk (CDR) Score

  • Low Risk:                   0 to 1
  • Moderate Risk:           2 to 5
  • High Risk:                   6 or greater

  

Cobalamin Deficiency Criteria List (CDCL)

I. Neurologic Manifestations (+2)

  • Numbness/tingling (including diagnosis of neuropathy)
  • Weakness of arms, legs, or trunk
  • Impaired vibration/position sense
  • Abnormal reflexes
  • Unsteady or abnormal gait
  • Balance problems
  • Difficulty ambulating
  • Dizziness
  • Tremor (including diagnosis of Parkinson’s)
  • Restless legs or diagnosis of restless leg syndrome
  • Visual disturbances
  • Forgetfulness/memory loss (including diagnosis of dementia or Alzheimer’s)
  • Mental status changes
  • Impotence/erectile dysfunction
  • Urinary/fecal incontinence
  • Developmental delay in infants & children (including diagnosis on the autism spectrum)

II. Psychiatric Manifestations (+2)

  • Depression/suicidal ideations, post-partum depression or perscribed antidepressant/psychiatric medications
  • Irritability/anxiety
  • Paranoia
  • Mania
  • Hallucinations
  • Psychosis
  • Violent behavior
  • Personality changes

III. Gastrointestinal Risks (+2)

  • Decreased stomach acid or atrophic gastritis
  • Autoimmune pernicious anemia
  • Helicobacter pylori
  • GERD or ulcer disease
  • Gastrectomy or intestinal resection
  • Gastric bypass surgery
  • Malabsorption syndromes
  • Crohn’s disease
  • Celiac disease (gluten enteropathy)
  • Chronic pancreatitis
  • Bacterial overgrowth (small bowel)
  • Fish tapeworm
  • Alcoholism
  • Malnutrition/eating disorders
  • Advanced liver disease
  • Transcobalamin II deficiency

IV.Hematologic Manifestations (+2)

  • Anemia
  • Macrocytosis
  • Microcytosis
  • Hypersegmented neutrophils
  • Anisocytosis
  • Leukopenia
  • Thrombocytopenia

V. Other Signs and Symptoms (+1)

  • Generalized weakness or fatigue
  • Shortness of breath, exertional dyspnea, or chest pain
  • Pallor
  • Hepatomegaly or splenomegaly
  • Loss of appetite/weight loss
  • Poor wound healing/decubitus ulcer
  • Cervical dysplasia
  • Tinnitus
  • Vitiligo
  • Glossitis

VI. Population at Risk (+1)

  • Age 60 and over
  • Fall or fall-related injury in the past year
  • Vegan/vegetarian/macrobiotic diet
  • Autoimmune and/or thyroid disorders
  • Family history of pernicious anemia
  • Proton pump inhibitor use
  • Metformin use
  • Nitrous oxide administration or abuse
  • Cancer patients
  • Chemotherapy
  • Radiation therapy
  • Occlusive vascular disorders (MI, CVA, DVT, PE)
  • Pregnancy
  • Breast-feeding
  • Iron deficiency
  • Infertility
  • Seizures
  • AIDS patients
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Chronic renal failure (hemodialysis patients)
  • Neck or back surgery