BackgroundOrganic factors are thought to be important in late-life depressive disorder but there have been few studies specifically of neurological signs.AimsTo compare neurological signs in a group of patients with late-onset depression and in healthy controls.MethodA case–control study comparing 50 patients with depression and 35 controls on three measures of central nervous system (CNS) signs: a structured CNS examination, the Neurological Evaluation Scale (NES) and the Webster rating scale for parkinsonism.ResultsAfter adjusting for major depression at the time of evaluation and prescription of tranquillisers, ratings on two of the NES sub-scales (complex motor sequencing and ‘other’ signs) and on the Webster scale were significantly higher (more impaired) in patients compared with controls (P <0.05). With logistic regression, the NES was the main measure predictive of group outcome. There were no differences in scores of vascular risk or white matter but patients had more atrophy.ConclusionsThe findings add to the evidence that late-life depression is associated with organic brain dysfunction, perhaps mediated by neurodegeneration or subtle vascular impairment. The use of the NES in subjects with depression should be replicated.