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The 2025 narrative review noted that despite the volume of preclinical work, well-controlled human trial data are scarce, and the regenerative findings should be interpreted accordingly (PMID 40789979)

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Additionally, research has explored NAD+'s role in acute neurological injuries such as stroke and traumatic brain injury using experimental models, with studies suggesting that rapid NAD+ depletion following brain injury contributes to neuronal death and that NAD+ restoration may be neuroprotective in research models

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NHS approach to B12 deficiency: NICE Clinical Knowledge Summaries recommend investigating B12 deficiency in patients presenting with macrocytic anaemia, unexplained neurological symptoms, or risk factors including pernicious anaemia, gastrectomy, malabsorption disorders, metformin use, proton pump inhibitors, or nitrous oxide exposure