In this paper we examine 20th century conceptual developments regarding dementia and the NDs, from the first recognition of their clinical and pathological characteristics, through recognition of their molecular and cellular attributes and, ultimately, to recognition of their dynamic and vascular origins. We introduce a new energy based causal model of these disabling neurologic conditions that provides vital insights into their origins and necessary treatment. The term 'causal' implies that future treatment of these conditions necessarily entails recognition and correction of underlying energy deficits.