Depressive symptoms the most prevalent clinical condition in the field of mood disorders in older populations. Depressive symptoms are associated to poorer morbidity and mortality, and is considered a component of frailty and intrinsic capacity. Dementia could overlap with DS in clinical and brain abnormalities. Moreover, there are sex-differences in the field of Neuro- and Gero-science. To date, no review has addressed the neuro-anatomical basis of DS in older adults using magnetic resonance imaging (MRI), neither has investigated the discrimination of dementia nor sex-differences. This narrative review investigated studies about older adults; depressive symptoms evaluation via MRI, and published in English or Spanish over the past 7 years. Moreover, it evaluated dementia discrimination and sex-related differences. The most accurate evidence showed cerebral small vessel disease as a predictor of depressive symptoms worsening. Most studies were cross-sectional, with a coarse dementia screening and sex-unrepresentative samples. Cingulate cortex and hippocampus showed a negative association to depressive symptoms, and Precuneus cortex a positive association; although these inferences require further investigation. Additional research is needed to identify the brain imaging signature of depressive symptoms in older population (if any), and if this would be associated with sex and individuals’level of frailty and intrinsic capacity.