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Although nerve conduction studies or somatosensory evoked potentials can identify abnormalities when the spinal MRI appears normal, their clinical utility in elderly patients is limited, and prompt empirical treatment with vitamin B12 is generally preferable to invasive diagnostic testing

Psychological screening for anxiety, depressive symptoms, and stress reactivity should be routine

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In addition, the oxidants may also originate from cytosolic enzyme systems, e.g., NADPH oxidases, and from exogenous triggers such as ionizing radiation and chemotherapeutics