Objective: Multiple Sclerosis (MS) is a chronic, progressive autoimmune disease of the CNS. Eighty-five percent of people begin with relapsing-remitting MS (RRMS) and 90% can develop secondary progressive (SPMS). Research in neuropsychological profiles characterizing the transition of RRMS to SPMS is limited. This paper describes neuropsychological findings of a 54-year old woman with RRMS who presented with progressive cognitive impairments. Method: Patient has a 22-year history of RRMS. Nine months prior to evaluation, brain MRI revealed enhancing left pons/cerebellum lesion along with new demyelinating lesions and general atrophy. After 6 months, imaging revealed no acute changes; however, she was hospitalized for increasing encephalopathy. EEG showed moderate slowing. Results: Examination showed average estimated premorbid IQ (WTAR = 98), WAIS-IV FSIQ of 79, and cognitive deficits characterized by severely impaired processing speed (WAIS-IV PSI = 53), visual scanning speed (Trails A-111”), cognitive flexibility (discontinued), visual naming (BNT T = 22), verbal fluency (FAS T = 14;Animals T = 12), motor dexterity (GPT T = 8R, 15L), and verbal learning (CVLT-II Trials 1-5 total T = 21). Encoding and retrieval of auditory information was mildly impaired. Initial encoding of visual information was impaired with intact delayed retention. Recognition was intact across domains. Mild impairments were found in visuoconstruction, spatial judgment, nonverbal abstract reasoning, and attention. Depression and anxiety were significantly elevated (BDI = 33, BAI = 23). Conclusion: Findings are consistent with the subcortical dysfunction profile in MS though indicate an aggressive degree of impairment (SPMS) that is consistent with neuroradiologic imaging of atrophy. Further, results also reveal cortical findings of dysnomia often accompanying disease progression. These findings add to the limited research on progressive states in MS.