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

Cobalamin Deficiency Risk (CDR) Score

  • Low Risk:                   0 to 1
  • At Risk:                      2 to 4
  • High Risk:                  5 or greater

  

I. Neurological Manifestations (+2)

  • Paresthesias
  • Weakness of arms, legs, or trunk
  • Unsteady gait, balance problems
  • Ataxia
  • Dizziness or light-headedness
  • Tremors
  • Restless legs
  • Lhermitte’s sign
  • Romberg’s sign
  • Abnormal Babinski reflex
  • Visual disturbances
  • Forgetfulness, short-term memory loss, or dementia
  • Mental status changes
  • Impotence, erectile dysfunction
  • Urinary or fecal incontinence
  • Impaired vibration, position sense
  • Abnormal reflexes
  • Seizures
  • Paralysis

II. Neuropsychiatric Manifestations (+2)

  • Depression, suicidal ideations
  • Diagnosis of mental illness or on psychiatric medications
  • Post-partum depression or psychosis
  • Anxiety
  • ADD/ADHD
  • Personality changes
  • Poor concentration or foggy thinking
  • Paranoia
  • Mania
  • Hallucinations
  • Psychosis
  • Violent behavior
  • Homicidal ideations

III. Hematologic Manifestations (+2)

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

IV. General Signs/Symptoms (+1)

  • Generalized weakness or fatigue
  • Shortness of breath
  • Pallor or jaundice
  • Frequent falls or near falls
  • Loss of appetite/weight loss
  • Frequent infections, poor wound healing
  • Orthostatic hypotension
  • Postural orthostatic tachycardia
  • Occlusive vascular disorder or thrombotic events (e.g., PE, DVT, CVA, MI, portal vein thrombosis)
  • Cervical dysplasia
  • Intrauterine growth retardation
  • Malnutrition
  • Glossitis
  • Tinnitus
  • Skin hyperpigmentation or hypopigmentation
  • Hepatomegaly or splenomegaly

V. Gastrointestinal Risks (+2)

  • Decreased stomach acid or atrophic gastritis
  • Gastroparesis
  • Helicobacter pylori infection
  • Giardiasis
  • GERD or ulcer disease
  • Gastrectomy (partial or complete), bariatric surgery
  • Ileal resection (partial or complete)
  • Malabsorption syndromes (e.g., Crohn’s disease, IBS, celiac disease)
  • Pancreatitis, pancreatic exocrine insufficiency
  • Small intestinal bacterial overgrowth
  • Diphyllobothrium latum (fish tapeworm)
  • Liver disease

VI. (a) Population at Risk (+2)

  • Vegans, vegetarians, macrobiotic diets
  • MTHFR gene mutation
  • Nitrous oxide administration or abuse
  • Eating disorders

VI. (b) Population at Risk (+1)

  • Age 50 and over
  • Pregnancy
  • Intrauterine growth retardation
  • Autoimmune disorders (e.g., thyroid, IDDM, lupus)
  • Family history of pernicious anemia
  • Proton pump inhibitor or H2-blocker use
  • Metformin use
  • Alcoholism
  • Dialysis patients
  • AIDS
  • Chemo- or radiation therapy
  • Phenylketonuria (PKU)
  • Down syndrome