Elderly patients are particularly sensitive to the neurologic side effects of psychotropic medications. This increased sensitivity may be related to brain structural changes associated with aging. In this pilot study, the authors report on the occurrence of caudate hyperintensities, using brain magnetic resonance imaging, in seven elderly depressed subjects who developed neuroleptic-induced parkinsonism. Caudate hyperintensities were not observed in any of the seven healthy elderly controls examined. These results suggest that caudate hyperintensities may render some elderly depressed patients susceptible to neuroleptic-induced parkinsonism.