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Abstract: Cognitive deficits affect approximately 50% of multiple sclerosis (MS) patients and are associated with disease-related neurodegeneration. Prior MS-studies found decision making impairments uncorrelated with patients’ cognitive functions. Brain correlates of decision making in MS have not been established. The Game of Dice Task (GDT) measures decision making under risk and was used here for the first time in MS patients. I tested healthy controls with either cognitive or brain measures (each n=20), 13 mildly-disabled relapsing-remitting (RR) (“RR-1”), 9 RRMS moderately-disabled (“RR-2”), and 10 secondary progressive (“SP”) MS patients. GDT was impaired in RR-2 and SP subgroups. GDT correlated with processing speed in all patients, but also with executive functions in RR-2 patients. Ventricular width measures indicated atrophy in RR-2 and SP. In all patients, atrophy correlated with decision making and processing speed. Decision making under risk is impaired in later-stage MS and is related to cognition and brain atrophy.