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Besides, disruption of MTR reaction leads to insufficient supply of methionine and S-adenosylmethionine (SAM), which is essential for the myelination of myelin sheath, phospholipids and neurotransmitter synthesis, for maintaining brain and nervous system function.51 Furthermore, high levels of homocysteine due to vitamin B 12 deficiency are associated with an increased risk of atherosclerotic vascular disease, and this in turn may increase the risk of cognitive impairment or dementia