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The 2024 Lancet Commission on dementia prevention identified 14 modifiable risk factors accounting for approximately 45% of global dementia cases and explicitly acknowledged that the causal mechanisms connecting these factors remain unknown. We propose a theoretical framework, Cumulative Agency Blockage and Biographical Aging: a Generative Etiology (CABBAGE), that provides those mechanisms. The framework rests on a single upstream proposition: that the chronic deprivation of need satisfaction, defined as the organismic capacity to know what one needs, to feel it, to express it, and to have it met through genuine response rather than imposed direction, produces cumulative biological damage through four distinct but interacting mechanistic lines: (1) allostatic load from chronic need deprivation; (2) repression and espression, the simultaneous compression and reactive displacement of neural tissue and function; (3) depletion and displacement of the neurochemical and structural substrates required for brain maintenance; and (4) iatrogenic and regulatory repression, the systematic compounding of biological damage by the medical and social systems nominally designed to prevent it. We apply these four lines to all 14 Lancet Commission risk factors and to 10 currently unexplained features of dementia phenomenology, generating 96 specific mechanistic explanations grounded in existing published biology. Movement, where it serves genuine need satisfaction, is protective and well-evidenced. It is not, however, the primary variable. An organism forced to move toward what a system has decided it needs, without recognition, expression, or genuine request, experiences no agency. The direction of movement can be imposed. The satisfaction of need cannot. Nonviolent Communication (Rosenberg, 2003) provides the most precise structural description of what need satisfaction looks like in practice: observation, feeling, need, request, met through voluntary and genuine response. Individuals who are attuned to their feelings, who name them and act on them, operate with dramatically higher agency across the lifespan. Pedagogies that support this from childhood, including autonomy-supportive and democratic approaches, represent the most upstream prevention available. The framework is not a claim that need deprivation causes all dementia. It is a claim that it causes substantially more than current models account for, that its absence from existing frameworks explains substantial unexplained variance, and that its inclusion would meaningfully alter both prevention and care.