Lesion load and activity in multiple sclerosis (MS) patients, as identified by conventional magnetic resonance imaging (MRI), correlate only moderately with patients clinical status and evolution. Cortical lesion number and volume measured with advanced MRI may provide better correlates to cognitive dysfunction and disability. In this work, we studied the clinical impact of advanced MRI metrics of cortical and subcortical lesion evolution in a cohort of early relapsing-remitting MS patients. The number and volume of lesions that “shrunk”, disappeared or remained stable over time were strong determinants of changes in cognition in our patients cohort.