Leukoaraiosis is a purely descriptive term for a radiological image, which describe confluent white matter abnormalities, detected by computed tomography (CT) or magnetic resonance imaging (MRI). The clinical presentation of this entity is heterogeneous and mostly severe. The relationship between Leukoaraiosis and depressive symptomatology is not yet completely understood. Ischemia seems to be the main favoring factor. Leukoaraiosis may be a risk factor for the onset, persistence, or worsening of depressive symptomatology in the elderly. Through a clinical case, we will address the different clinical and therapeutic aspects of this relationship.