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Charles E. Wells, MD

Arch Gen Psychiatry. 1972;26(4):385-388.

Abstract
For most patients suffering slowly progressive dementia due to diffuse brain disease, no precise cause can be uncovered. Although arteriosclerotic cerebral vascular disease is a commonly accepted diagnosis, no precise relationship has been shown between this type of dementia and underlying vascular disease. A direct relationship has been established between severity of dementia and extent of brain pathology. Although there is no predictable underlying brain morphology, for some there is evidence for infection with a "slow virus," for others impaired cerebrospinal fluid absorption, and for still others a relationship to amyloidosis. No biochemical defect has been demonstrated which cannot be explained on the basis of brain cell destruction alone. These observations indicate a variety of causes known and unknown for these so-called primary dementias. With increasing understanding, a new rationale for diagnosis and treatment of these patients will evolve.

Author Affiliations
Nashville, Tenn

From the Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tenn.

Footnotes
Accepted for publication Aug 21, 1971.

Reprint requests to the Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tenn 37203 (Dr. Wells).