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Keep in mind that the clinical manifestations of vitamin B12 deficiency differ depending on the degree and duration of deficiency, but some of the most common symptoms of a B12 deficiency include 4 : Anemia Chronic fatigue Shortness of breath Heart palpitations Pallor Skin hyperpigmentation Glossitis Infertility Osteoporosis Sensory loss Abnormal balance or reflexes Cognitive impairment Memory loss Older adults are at a higher risk for vitamin B12 deficiency, as are those on a vegetarian or vegan diet, as dietary B12 is found in animal products