Heghine Khachatryan: Dementia at the Intersection of Hematology and Hemostasis
Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn:
“Dementia: At the Intersection of Hematology and Hemostasis
Emerging evidence increasingly supports that cognitive impairment is often multifactorial, with significant contributions not only from metabolic abnormalities, but also from hemostatic dysregulation.
In the diagnostic approach to dementia, the concept of reversible causes must be expanded to include thrombotic–hemostatic mechanisms and microcirculatory dysfunction.
Why Hemostasis Matters in Cognitive Decline
Cerebral function is highly sensitive to:
- Microthrombosis
- Endothelial dysfunction
- Chronic hypoperfusion
- Inflammation-driven vascular injury
These processes contribute to vascular cognitive impairment, often under-recognized within the broader dementia spectrum.
Hemostatic Red Flags
- Unexplained thrombosis
- Recurrent stroke / TIA
- Silent cerebral infarcts
- Elevated D-dimer / fibrinogen
- Antiphospholipid antibodies
- Cytopenias or macrocytosis
Key Hemostatic Contributors
- Antiphospholipid syndrome (APS)
- Hypercoagulable states
- Hyperviscosity syndromes (WM, myeloma)
- Malignancy-associated microthrombosis
- Endothelial dysfunction
What to Include in Workup
- Coagulation profile
- D-dimer
- APS panel
- Thrombophilia testing (selected cases)
- Serum viscosity / SPEP
Take-Home Message
Dementia is not always purely neurodegenerative.
In selected cases, it may reflect microthrombotic and hemostatic pathology – potentially modifiable if identified early.
Call to Action
Hematologists should be actively involved in the multidisciplinary evaluation of cognitive disorders.
Because sometimes, the origin of cognitive decline lies in the hemostatic system. ”
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