Celia Oreja-Guevara, MD, PhD, University Hospital San Carlos, Madrid, Spain, discusses recent discoveries on the connection between cognitive impairment and brain atrophy in multiple sclerosis (MS). Cognitive impairment is a common and often overlooked, manifestation in MS, affecting between 60-80% of patients. These alternations can occur early in the disease course and significantly impact a patient’s quality of life, even in the absence of significant physical disability. Recent imaging data has demonstrated the association of cognitive impairment severity with whole-brain atrophy, as well as thalamic volume loss and cortical gray matter loss. These findings demonstrate the need for novel treatments that reduce brain volume loss. This interview took place at the European Academy of Neurology (EAN) 2022 Congress in Vienna, Austria.