What is NPH? Understanding the condition causing Billy Joel to cancel his tour

WASHINGTON — Famed singer Billy Joel announced Friday that he was recently diagnosed with a neurological condition known as Normal Pressure Hydrocephalus. 

As a result, the “Piano Man” musician is canceling all of his concerts scheduled for 2025 and into next year as he works to recover.  

According to the Cleveland Clinic, normal pressure hydrocephalus (NPH) is a condition that happens when cerebrospinal fluid builds up inside your skull and presses on your brain. The condition is most likely in people over the age of 65.

The disorder has the word “normal” in its name, but it doesn’t mean everything is fine. It’s named that way because when doctors perform a spinal tap, the pressure they see is normal, making the disorder more difficult to diagnose, the Alzheimer’s Association explains on its website. 

But as the brain’s fluid-filled chambers, called ventricles, expand because of the extra fluid in them, it can push on and potentially damage nearby brain tissue. 

On the surface, NPH can cause difficulty walking, problems with thinking and reasoning, and loss of bladder control. The Alzheimer’s Association says that the symptoms are similar to those experienced by people living with Alzheimer’s, dementia or Parkinson’s disease. 

Somebody with NPH may feel off-balance, as though they’re walking on a boat. This is one of the earliest and easiest-to-spot symptoms. The loss of motor function can continue until the patient loses control of some automatic functions, such as urination. 

They can also experience mild dementia, and a loss of detailed thinking skills. A patient with NPH can lose interest in activities they once enjoyed, forget basic things and potentially have a change in their personality. 

Because it’s so similar to other neurological disorders, NPH can often be overlooked or misdiagnosed as Alzheimer’s or another disease. 

While NPH causes dementia-like symptoms, it’s often treatable or even reversible with proper treatment, especially if caught early, The Cleveland Clinic said. 

However, the only known treatment that is effective at controlling the disease long-term is surgical. The surgery involves having a tube, called a shunt, inserted into the brain to drain excess cerebrospinal fluid. 

This treatment can lessen and in some cases even reverse the effects of NPH. 

Other treatments, such as a high-volume spinal tap to remove excess fluid, don’t often help those dealing with the disease. 

The Hydrocephalus Association, a nonprofit that studies the condition, estimates that around 800,000 older Americans have NPH. But that number could be higher because it’s often misdiagnosed as Alzheimer’s, Parkinson’s, or dementia. Less than 20% are properly diagnosed, according to Yale Medicine.