Over the past 5 years, the NFL and NFL-Players Association (NFL-PA) have made significant strides in improving player safety when it comes to head injuries. This has included expanding sideline medical personnel, adding an independent neurological consultant, rule changes regarding helmet to helmet contact, and perhaps most importantly, player education.

With that said, there is still significant room for improvement, especially when it comes to the role of neurologists. Unfortunately, it may be too late for many retired players who are now showing signs of early dementia, ALS, and Parkinson’s disease.

TRENDING ON CPA: Preventing Opioid Abuse: Impact of Tamper-Resistant Formulations  

I am currently evaluating retired NFL players for possible neurological sequela of concussion and repetitive sub concussive hits. In looking at the first 50 players, our preliminary results demonstrate an exponentially high incidence of traumatic brain injury (TBI) (close to 50%) with correlative neuropsychological testing in these individuals. This is the first study in living players showing a direct link between concussive/sub-concussive hits and TBI. It also provides a possible explanation for the cognitive issues players are reporting and — given that approximately 30 to 40% of individuals with TBI go on to develop progressive dementia — a plausible link to CTE.

The field of concussions is rapidly evolving. As a result and as is often the case when things advance quickly, information is not accurately disseminated and some issues get overlooked in the conversation.

One area that needs more visibility is a little-known but increasingly common neurologic condition called Pseudobulbar affect (PBA), which can lead to uncontrollable, sudden outbursts of crying and/or laughing that d not match what a person is feeling emotionally. PBA is not limited to sports-related brain injuries; it can occur in people who have suffered TBI as a result of car accidents or falls, or in those with neurologic conditions such as multiple sclerosis, ALS, Parkinson’s disease, stroke, and AD.

It is estimated that nearly 7 million Americans suffer from PBA, and that number may go up as awareness rises. In a poll conducted by the non-profit organization for retired NFL players, Gridiron Greats, which asked  retired NFL players about head injuries sustained during their career,99% of the over 500 respondents said they experienced head trauma or injury during their football career, and one-third experienced symptoms of PBA.3 Even more telling, 84% of those reporting PBA-like symptoms never discussed their crying and/or laughing outbursts with their healthcare professional, and only half of the 16% who talked to healthcare professionals received a diagnosis or explanation.

This article originally appeared on Neurology Advisor