{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T20:24:57Z","timestamp":1776975897931,"version":"3.51.4"},"reference-count":66,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T00:00:00Z","timestamp":1758326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: The ability to drive is closely linked to participation in daily activities and quality of life in people living with neurological disorders. Cognitive deficits in people with multiple sclerosis (pwMS) are known to hinder this ability, yet concrete fitness-to-drive criteria remain elusive and assessment guidelines lack uniformity. A plethora of cognitive tests have provided associations with various aspects of driving performance and on-road behavior; however, several studies reveal limitations and inconsistencies in most tests\u2019 sensitivity and predictive effect. Novel and resurfaced modalities for cognitive assessment, in the form of advanced imaging techniques and electrophysiological studies, may offer improved sensitivity in driving-related abilities in earlier and milder stages. Their application in addition to evaluations in driving simulators may aid future research and enhance the quality of evidence to inform decision-making. Methods: We searched for the relevant literature in the PubMed database and synthesized the available findings for the applications of currently clinically used cognitive tests, markers derived from functional magnetic resonance imaging (fMRI) and diffuse tensor imaging (DTI), as well as event-related potentials (ERP). Results: Advanced imaging modalities and ERP studies may better capture neurobiological changes that lead to driving impairment in pwMS, and they may also be applied to detect cognitive alterations earlier and with greater precision, helping to predict driving difficulties in this population. Conclusions: Novel tools and driving simulator settings could improve our understanding of the relation between cognition and driving in pwMS, enhance protocol homogeneity in driving studies, and aid in the formation of guidelines. The evidence in this review supports an increase in their application in future studies.<\/jats:p>","DOI":"10.3390\/brainsci15091017","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T08:37:39Z","timestamp":1758530259000},"page":"1017","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating a Misty Road: Novel Ways to Study the Impact of Cognition on Driving Performance in Multiple Sclerosis"],"prefix":"10.3390","volume":"15","author":[{"given":"Ioannis","family":"Nikolakakis","sequence":"first","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Grigoriadis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5770-4303","authenticated-orcid":false,"given":"Nefeli","family":"Dimitriou","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Therapy, University of Ioannina, 45332 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4300-2826","authenticated-orcid":false,"given":"Dimitrios","family":"Parisis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7495-6863","authenticated-orcid":false,"given":"Grigorios","family":"Nasios","sequence":"additional","affiliation":[{"name":"Department of Speech and Language Therapy, University of Ioannina, 45332 Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3216-9025","authenticated-orcid":false,"given":"Lambros","family":"Messinis","sequence":"additional","affiliation":[{"name":"Laboratory of Neuropsychology and Behavioral Neuroscience, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4737-3707","authenticated-orcid":false,"given":"Christos","family":"Bakirtzis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e37297","DOI":"10.1097\/MD.0000000000037297","article-title":"Review of Multiple Sclerosis: Epidemiology, Etiology, Pathophysiology, and Treatment","volume":"103","author":"Haki","year":"2024","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1212\/WNL.0000000000000768","article-title":"Atlas of Multiple Sclerosis 2013: A Growing Global Problem with Widespread Inequity","volume":"83","author":"Browne","year":"2014","journal-title":"Neurology"},{"key":"ref_3","unstructured":"(2025, July 15). Global Status Report on Road Safety 2018. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241565684."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1034\/j.1600-0404.2002.1o165.x","article-title":"Driving Accident Frequency Increased in Patients with Multiple Sclerosis: Driving and Multiple Sclerosis","volume":"105","author":"Lings","year":"2002","journal-title":"Acta Neurol. Scand."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zai, S.S., Buhmann, C., Pedersen, A., and P\u00f6ttgen, J. (2024). Factors Affecting Driving Performance in Patients with Multiple Sclerosis\u2014Still an Open Question. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1369143"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1615\/CritRevPhysRehabilMed.2017020023","article-title":"Driving Ability among Patients with Multiple Sclerosis: Can Legislation Be Provided on the Matter?","volume":"28","author":"Fragoso","year":"2016","journal-title":"Crit. Rev. Phys. Rehabil. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1053\/apmr.2002.34279","article-title":"Motor Vehicle Crashes and Violations among Drivers with Multiple Sclerosis","volume":"83","author":"Schultheis","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1053\/apmr.2002.33730","article-title":"Assessing Functional Status: Exploring the Relationship between the Multiple Sclerosis Functional Composite and Driving","volume":"83","author":"Shawaryn","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1177\/1352458507080467","article-title":"Cognitive Abilities as Predictors of Safety to Drive in People with Multiple Sclerosis","volume":"14","author":"Lincoln","year":"2008","journal-title":"Mult. Scler. Houndmills Basingstoke Engl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1177\/1352458512451944","article-title":"Predictors of Driving in Individuals with Relapsing\u2013Remitting Multiple Sclerosis","volume":"19","author":"Akinwuntan","year":"2013","journal-title":"Mult. Scler. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1159\/000073057","article-title":"Assessment of Driving Performance in Patients with Relapsing-Remitting Multiple Sclerosis by a Driving Simulator","volume":"50","author":"Kotterba","year":"2003","journal-title":"Eur. Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Seddiq Zai, S., Heesen, C., Buhmann, C., Das Nair, R., and P\u00f6ttgen, J. (2022). Driving Ability and Predictors for Driving Performance in Multiple Sclerosis: A Systematic Review. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.1056411"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"108431","DOI":"10.1016\/j.clineuro.2024.108431","article-title":"Investigating the Relationship between Multiple Sclerosis Disability and Driving Performance: A Comparative Study of the Multiple Sclerosis Functional Composite and Expanded Disability Status Scale","volume":"244","author":"Esquivel","year":"2024","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.apmr.2007.12.049","article-title":"The Contribution of Cognition and Spasticity to Driving Performance in Multiple Sclerosis","volume":"89","author":"Marcotte","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.apmr.2009.09.026","article-title":"Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis","volume":"91","author":"Schultheis","year":"2010","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1016\/j.apmr.2016.10.008","article-title":"Determinants of On-Road Driving in Multiple Sclerosis","volume":"98","author":"Devos","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1177\/1352458517723991","article-title":"On-Road Assessment of Fitness-to-Drive in Persons with MS with Cognitive Impairment: A Prospective Study","volume":"24","author":"Morrow","year":"2018","journal-title":"Mult. Scler. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1111\/ene.13690","article-title":"Validation of a Short Cognitive Battery to Screen for Fitness-to-drive of People with Multiple Sclerosis","volume":"25","author":"Akinwuntan","year":"2018","journal-title":"Eur. J. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.trf.2018.10.014","article-title":"A Strategic Driving Maneuver That Predicts On-Road Outcomes in Adults with Multiple Sclerosis","volume":"60","author":"Krasniuk","year":"2019","journal-title":"Transp. Res. Part F Traffic Psychol. Behav."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.msard.2018.08.005","article-title":"Evidence of Attentional Impairments Using Virtual Driving Simulation in Multiple Sclerosis","volume":"25","author":"Harand","year":"2018","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1016\/j.apmr.2018.12.029","article-title":"Clinical Determinants of Fitness to Drive in Persons With Multiple Sclerosis: Systematic Review","volume":"100","author":"Krasniuk","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"104930","DOI":"10.1016\/j.msard.2023.104930","article-title":"Prospective Analyses of Alertness, Sleep, and Fitness to Drive One Year after de Novo Multiple Sclerosis Diagnosis","volume":"79","author":"Ottersbach","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1016\/j.apmr.2014.05.022","article-title":"Neuropsychological Performance, Brain Imaging, and Driving Violations in Multiple Sclerosis","volume":"95","author":"Dehning","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/1539449217718841","article-title":"Visual Correlates of Fitness to Drive in Adults With Multiple Sclerosis","volume":"38","author":"Classen","year":"2018","journal-title":"OTJR Occup. Ther. J. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1111\/ene.15755","article-title":"Car Accidents in Drivers with Parkinson\u2019s Disease or Multiple Sclerosis: A Swedish Nationwide Study","volume":"30","author":"Anjemark","year":"2023","journal-title":"Eur. J. Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1080\/13854046.2013.797500","article-title":"The Role of Processing Speed in the Brief Visuospatial Memory Test\u2014Revised","volume":"27","author":"Tam","year":"2013","journal-title":"Clin. Neuropsychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.msard.2019.07.027","article-title":"Cognitive and Brain Reserve in Multiple Sclerosis\u2013\u2013A Cross-Sectional Study","volume":"35","author":"Ifantopoulou","year":"2019","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.trf.2025.06.017","article-title":"Social Cognition and Driving: Theory of Mind Is Associated with Drivers\u2019 Hazard Perception","volume":"114","author":"Goodhew","year":"2025","journal-title":"Transp. Res. Part F Traffic Psychol. Behav."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lin, X., Zhang, X., Liu, Q., Zhao, P., Zhong, J., Pan, P., Wang, G., and Yi, Z. (2021). Empathy and Theory of Mind in Multiple Sclerosis: A Meta-Analysis. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.628110"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e2452038","DOI":"10.1001\/jamanetworkopen.2024.52038","article-title":"Major Depressive Disorder and Driving Behavior Among Older Adults","volume":"7","author":"Babulal","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e401","DOI":"10.1097\/j.pain.0000000000002388","article-title":"Impact of Chronic Pain on Driving Behaviour: A Systematic Review","volume":"163","author":"Vaezipour","year":"2022","journal-title":"PAIN"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.aap.2009.06.007","article-title":"Drivers\u2019 Misjudgement of Vigilance State during Prolonged Monotonous Daytime Driving","volume":"41","author":"Schmidt","year":"2009","journal-title":"Accid. Anal. Prev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"102607","DOI":"10.1016\/j.msard.2020.102607","article-title":"Real-Time Assessment of Daytime Sleepiness in Drivers with Multiple Sclerosis","volume":"47","author":"Devos","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Yuen, N.H., Tam, F., Churchill, N.W., Schweizer, T.A., and Graham, S.J. (2021). Driving With Distraction: Measuring Brain Activity and Oculomotor Behavior Using fMRI and Eye-Tracking. Front. Hum. Neurosci., 15.","DOI":"10.3389\/fnhum.2021.659040"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Fang, C., Zhang, Y., Zhang, M., and Fang, Q. (2020). P300 Measures and Drive-Related Risks: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155266"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.wneu.2024.06.003","article-title":"Applications of Functional Magnetic Resonance Imaging to the Study of Functional Connectivity and Activation in Neurological Disease: A Scoping Review of the Literature","volume":"189","author":"Leskinen","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1093\/cercor\/bhn059","article-title":"Resting-State Functional Connectivity Reflects Structural Connectivity in the Default Mode Network","volume":"19","author":"Greicius","year":"2009","journal-title":"Cereb. Cortex"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.neuroimage.2013.09.071","article-title":"Fusing DTI and FMRI Data: A Survey of Methods and Applications","volume":"102","author":"Zhu","year":"2014","journal-title":"NeuroImage"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1038\/nn.4406","article-title":"Activity Flow over Resting-State Networks Shapes Cognitive Task Activations","volume":"19","author":"Cole","year":"2016","journal-title":"Nat. Neurosci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103076","DOI":"10.1016\/j.nicl.2022.103076","article-title":"Task- and Resting-State fMRI Studies in Multiple Sclerosis: From Regions to Systems and Time-Varying Analysis. Current Status and Future Perspective","volume":"35","author":"Rocca","year":"2022","journal-title":"NeuroImage Clin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1007\/s00429-021-02241-8","article-title":"Navigating the Link between Processing Speed and Network Communication in the Human Brain","volume":"226","author":"Imms","year":"2021","journal-title":"Brain Struct. Funct."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Schoonheim, M.M., Meijer, K.A., and Geurts, J.J.G. (2015). Network Collapse and Cognitive Impairment in Multiple Sclerosis. Front. Neurol., 6.","DOI":"10.3389\/fneur.2015.00082"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e2517","DOI":"10.1212\/WNL.0000000000201264","article-title":"MAGNIMS Study Group. Investigating Functional Network Abnormalities and Associations With Disability in Multiple Sclerosis","volume":"99","author":"Carotenuto","year":"2022","journal-title":"Neurology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1148\/radiol.2019182623","article-title":"Reduced Network Dynamics on Functional MRI Signals Cognitive Impairment in Multiple Sclerosis","volume":"292","author":"Eijlers","year":"2019","journal-title":"Radiology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.nicl.2016.11.026","article-title":"Structural Networks Involved in Attention and Executive Functions in Multiple Sclerosis","volume":"13","author":"Llufriu","year":"2017","journal-title":"NeuroImage Clin."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Welton, T., Meng, D., das Nair, R., Constantinescu, C.S., Auer, D.P., and Dineen, R.A. (2023). Fronto-Parietal Network Dynamics to Understand Deficits in Attention Performance in Multiple Sclerosis. medRxiv, medRxiv:2023.07.08.23292404.","DOI":"10.1101\/2023.07.08.23292404"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.neuroimage.2015.07.053","article-title":"Default Mode Network Connectivity during Task Execution","volume":"122","author":"Vatansever","year":"2015","journal-title":"NeuroImage"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Ogihara, T., Tanioka, K., Hiroyasu, T., and Hiwa, S. (2022). Predicting the Degree of Distracted Driving Based on fNIRS Functional Connectivity: A Pilot Study. Front. Neuroergon., 3.","DOI":"10.3389\/fnrgo.2022.864938"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.neuropsychologia.2018.05.002","article-title":"Connectivity Patterns in Cognitive Control Networks Predict Naturalistic Multitasking Ability","volume":"114","author":"Wen","year":"2018","journal-title":"Neuropsychologia"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"148827","DOI":"10.1016\/j.brainres.2024.148827","article-title":"The Use of Event-Related Potentials in the Investigation of Cognitive Performance in People with Multiple Sclerosis: Systematic Review","volume":"1832","author":"Vlieger","year":"2024","journal-title":"Brain Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.clinph.2024.04.024","article-title":"Relationship between Event-Related Potentials and Cognitive Dysfunction in Multiple Sclerosis: A Systematic Review","volume":"163","author":"Ferreira","year":"2024","journal-title":"Clin. Neurophysiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s41983-023-00726-3","article-title":"P300 Event-Related Potentials in Patients with Multiple Sclerosis","volume":"59","author":"Kaddoori","year":"2023","journal-title":"Egypt. J. Neurol. Psychiatry Neurosurg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10111-018-0485-z","article-title":"Event-Related Potentials as Indices of Mental Workload While Using an in-Vehicle Information System","volume":"21","author":"Kircher","year":"2019","journal-title":"Cogn. Technol. Work"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1167\/iovs.03-1213","article-title":"Subclinical Visual Involvement in Multiple Sclerosis: A Study by MRI, VEPs, Frequency-Doubling Perimetry, Standard Perimetry, and Contrast Sensitivity","volume":"46","author":"Sisto","year":"2005","journal-title":"Investig. Opthalmology Vis. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"185","DOI":"10.37897\/RJN.2013.4.5","article-title":"The Incidence of Visual Subclinical Manifestations in Multiple Sclerosis","volume":"12","author":"Grecescu","year":"2013","journal-title":"Rom. J. Neurol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.trf.2021.12.006","article-title":"Utilizing Driving Simulators for Persons with Multiple Sclerosis: A Scoping Review","volume":"85","author":"Krasniuk","year":"2022","journal-title":"Transp. Res. Part F Traffic Psychol. Behav."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Pierella, C., Romani, P., Gandolfi, F., Podda, J., Massone, A., Tacchino, A., Brichetto, G., Canessa, A., Ricci, S., and Casadio, M. (2022, January 21\u201324). Driving Simulator for Assessing Driving Skills of People with Multiple Sclerosis: A Pilot Study. Proceedings of the 2022 9th IEEE RAS\/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob), Seoul, Republic of Korea.","DOI":"10.1109\/BioRob52689.2022.9925411"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"104150","DOI":"10.1016\/j.msard.2022.104150","article-title":"Symbol Digit Modalities Test Predicts Decline of Off-Road Driving Ability in Japanese Patients with Multiple Sclerosis","volume":"68","author":"Maeta","year":"2022","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1016\/j.apmr.2025.01.146","article-title":"User-Friendliness of a Portable Driving Simulator to Retrain Impaired Driving Skills in Individuals with Parkinson Disease and Multiple Sclerosis\u2014A Pilot Study","volume":"106","author":"Durairaj","year":"2025","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.apmr.2013.08.294","article-title":"Improvement of Driving Skills in Persons With Relapsing-Remitting Multiple Sclerosis: A Pilot Study","volume":"95","author":"Akinwuntan","year":"2014","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"191","DOI":"10.2147\/IJGM.S17475","article-title":"Support for Stroke Patients in Resumption of Driving: Patient Survey and Driving Simulator Trial","volume":"4","author":"Hitosugi","year":"2011","journal-title":"Int. J. Gen. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jsr.2024.08.002","article-title":"The Effectiveness of Driving Simulator Training on Driving Skills and Safety in Young Novice Drivers: A Systematic Review of Interventions","volume":"91","author":"Krasniuk","year":"2024","journal-title":"J. Safety Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"103108","DOI":"10.1016\/j.nicl.2022.103108","article-title":"The Network Collapse in Multiple Sclerosis: An Overview of Novel Concepts to Address Disease Dynamics","volume":"35","author":"Schoonheim","year":"2022","journal-title":"NeuroImage Clin."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.neuroimage.2017.09.021","article-title":"Brain Mapping in Multiple Sclerosis: Lessons Learned about the Human Brain","volume":"190","author":"Filippi","year":"2019","journal-title":"NeuroImage"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"667","DOI":"10.3390\/neurosci3040048","article-title":"Cognitive Impairment in Multiple Sclerosis: An Update on Assessment and Management","volume":"3","author":"Portaccio","year":"2022","journal-title":"NeuroSci"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2174\/1874205X01812010031","article-title":"The Rationale for Monitoring Cognitive Function in Multiple Sclerosis: Practical Issues for Clinicians","volume":"12","author":"Bakirtzis","year":"2018","journal-title":"Open Neurol. J."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/9\/1017\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:24Z","timestamp":1760035584000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/9\/1017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,20]]},"references-count":66,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["brainsci15091017"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15091017","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,20]]}}}