The hallmarks of cognitive impairment (CI) in MS are slowed cognitive processing and deficient learning, as originally described by Charcot nearly 150 years ago. This session undertakes the question of what specific tools should be applied in clinical routine care of MS patients, and how often they should be applied? Cognitive assessment is becoming a mainstay of routine care in MS clinics, as a result of initiatives such as the Brief International Cognitive Assessment for MS (BICAMS) and the MS Outcomes Assessment Consortium (MSOAC). Computerized Assessment Neuropsychological Devices (CNADs) are more common and were recently reviewed by a Cognition Work Group from the National MS Society (NMSS). In this lecture, we will cover recent research on CI that presents as progressive decline, and, acute disease activity. Using the Symbol Digit Modalities Test (SDMT), slowed cognitive processing has been documented in clinical relapses, and in isolation, presumably an isolated transient decline in cognition. The authors will review recommendations of a recent National MS Society (NMSS) consensus opinion paper, and discuss ways to apply conventional and computer-assisted methods to address various triggers for neuropsychological evaluation, including cognitive relapse, treatment monitoring, negative work events, and psychiatric exacerbation.