It is well known that the neurologic manifestations of vitamin B12 deficiency 
can occur in the absence of anemia. The authors recently observed two elderly 
patients who presented to a chronic care institution with the diagnosis of 
dementia, and in both individuals low serum B12 levels were found in conjunction 
with abnormal Schilling tests. In neither of these two patients was there anemia 
or macrocytosis. After receiving parenteral B12 injections there was improvement 
noted in cognitive functions as well as in activities of daily living. The 
authors are reporting these patients to alert clinicians to the fact that 
pernicious anemia in the elderly can first present with low serum B12 levels and 
neurologic abnormalities in the absence of anemia or macrocytosis.