A family member (70 yr old female) recently started taking B-12 5mg methylcobalamin tablets in an effort to increase their B-12 levels. Before starting to take the B-12 tablets they had symptoms that included the following:

1. Daily fatigue
2. Light-headed when standing up
3. Forgetfulness/Memory issues (mixing up names, forgetting directions, etc)
4. Low appetite
5. Always feeling cold

It has now been 3 weeks since she started taking the daily 5mg tablet and during that 3 weeks some of her symptoms have seem to worsen.

1. Her daily fatigue has gotten worse
2. Her memory seems to have gotten worse (forgetting family members' names, not remembering things that happened a day or two ago, thinking that family members who are dead are still alive, etc)

When starting B-12 treatment does symptoms tend to get worse before they get better or is something else causing this?

Do you have a reference number for her blood levels? Or did you just do this on your own?

The elderly are prone to thyroid changes too...and many of the symptoms you list could be hypothyroid as well. That needs to be checked out.

Sometimes the elderly get so low, they need injections very frequently. Every day for a week, then once a week, then depending on the blood levels, a less frequent schedule.

If the oral absorption is too slow to fix a process of deterioration, then the deterioration continues, in spite of the oral supplement. Remember only a tiny fraction of the dose is absorbed orally if taken correctly --on an empty stomach.
13mcg out of 1000mcg/tablet. Daily injections would be much faster compared to this.

Concerning her B-12 levels she has not had a test to find out exactly what her levels are. Every year in February a local hometown pharmacy offers a service where individuals can come in and pay to get a full blood test to check the most common things. This past February (2014) we had the test done on her (it doesn't check for B-12 but it did do a full profile on the thyroid) and all of here thyroid numbers (TSH, T4, T3, Free Thyroxine) were in the middle of the normal ranges. Every year that she has had this test for the past 8 years her thyroid numbers have always been normal. This test did check for Vitamin D and on that she was low 38.9 (range 32.0 to 100.0). As a result of that she is now taking D3 supplements to get that value up.

As a result of a botched medical procedure, about 12 years ago, she now refuses to go to any doctor because she thinks they will mess something up. After doing research on all her symptoms it kept coming back to the possibility of B-12 deficiency. I thought that since B-12 is not toxic I would start here on 5mg and hope that it would help. But, over the past 3 weeks she has become more tired and her memory has become worse. She doesnt seem to know what day it is and sometimes she doesnt even recognize some of her family members.

I am sorry that this is happening. But I don't think the B12 is the issue. I do think she needs to be seen. If it is low B12, the oral form is too slow at this point. Once fixed with aggressive injections, one could maintain with oral. But something else could be going on too.

The elderly can get low potassium, diabetes, Alzheimer's, kidney failure, and all sorts of other things that give similar symptoms.

I think a visit to a doctor, is in order now.

Well after talking to a few friends who have taken B-12 for energy when working out a few recommended a place in a nearby town that gives B-12 injections. I checked them out and they have offices statewide and one service they offer is B-12 injections but it appears that they use either Cyanocobalamin or Hydroxocobalamin. I thought that maybe I could tell her that I was getting tired lately and I know that she is tired lately and we could go together to get B-12 shots so that she feels more comfortable about it.

But since they only use those two forms of B-12 would either work as injections since it is not the methylcobalamin type?

The hydroxocobalamin is an activated form. Use that one.
You don't know if she is methylating or not, so, I'd avoid the cyano form for now.

But I have to warn you, if she continues to show deterioration, even with the injections you need to have her seen by a doctor.