Table 1.

Summary of the case scenarios

Case No.	Case description	Cognitive function	Physical status	MRI findings
1	36 year-old female, known case of MS, on GA	Cognitive decline over 3 years	Stable	Stable
2	41 year-old man, borderline cognitive function at MS diagnosis two years ago, on fingolimod	Severe cognitive decline in the last 6 months, other possible causes ruled out	Stable	New T2 lesions and severe cerebral atrophy
3	45 year-old female, known case of MS, on IFN-beta 1a for 11 years	No previous cognitive evaluation, now shows impaired information processing speed (SDMT, PASAT: z score < -1.5) and delayed recall (CVLT-II delayed recall: z score < -1.5)	Stable	Cerebral atrophy
4	32 year-old female, diagnosed with MS one year ago, on GA (plans for pregnancy)	Impaired information processing speed (SDMT: z score < -1.5), no change	Stable	Mild cortical atrophy at diagnosis, no change
5	24 year-old male student, recently diagnosed with MS, IFN-beta 1a started, comes for the second opinion	Impaired information processing speed (SDMT, PASAT: z score < -1.5) (other causes ruled out) and delayed recall (CVLT-II delayed recall: z score < -1.5)	Right-sided hemiparesthesia (recovery with IVMP)	Brain MRI: 5 periventricular lesions (2 enhancing, 1 juxtacortical lesion) Spine MRI: normal
6	38 year-old man, known case of MS for 3 years, on DMF	Evaluation not performed previously, now shows impaired information processing speed (SDMT, PASAT: z score < -1.5)	One mild non-disabling attack each year since then	Brain MRI: 1 enhancing periventricular lesion, otherwise stable Spine MRI: stable

MS: Multiple Sclerosis; GA: Glatiramer acetate; MRI: Magnetic resonance imaging; SDMT: Symbol Digit Modalities Test; PASAT: Paced Auditory Serial Addition Test; CVLT-II: California Verbal Learning Test® Second Edition; IFN-beta: Interferon-β; DMF: Dimethyl fumarate; IVMP: Intravenous methylprednisolone