Dementia and the clenched fist syndrome keeps one or both hands tightly clenched. It is seen in all groups; hand dominance or compensation is not a factor. It usually follows a minor inciting incident and is associated with swelling, pain, and paradoxical stiffness. No organic disease can be found and extension of the fingers is always possible under anesthesia. Psychiatrically the patient is classified as having severe anger and poor defense. The prognosis is poor.