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Billy Joel, 76, revealed Friday that he is bowing out of his 2025 tour because he has been diagnosed with the brain condition normal pressure hydrocephalus (NPH).
Joel said his symptoms had been exacerbated by his recent live performances, “leading to problems with hearing, vision, and balance.”
He was advised by his doctor to refrain from performing while he undergoes treatment and takes time to recover.
The “New York State of Mind” singer postponed several tour dates in March due to a “medical condition” that forced him to “undergo physical therapy under the supervision of his doctors” following an onstage fall in February.
“I’m sincerely sorry to disappoint our audience, and thank you for understanding,” said Joel in response to the latest round of cancelations.
What is NPH?
NPH occurs when cerebrospinal fluid (CSF) buildup inside or around the brain disrupts cognitive functioning.
CSF provides nutrients to and removes waste products from the brain while cushioning the brain and spinal cord from force. Typically, adults have five fluid ounces of CSF, with the body constantly producing, circulating, and reabsorbing the fluid to keep that level constant.
However, when the body fails to circulate or reabsorb CSF correctly, the fluid can accumulate.
Typically, this buildup is gradual enough that the pressure inside the skull increases, but stays within normal range, and the fluid runs into the brain’s ventricles, which can hold some of the overflow.
Yet, if the CSF keeps collecting, the brain begins to compres,s and if this compression lasts too long, it can cause permanent damage.
NPH is most common in seniors, with the average age of diagnosis being 70.
NPH affects about 0.2% of people between the ages of 70 and 80, and about 5.9% of people over 80. NPH is very rare in people under 65, only affecting about 0.003% of people in that demographic.
What are the symptoms?
NPH symptoms begin gradually and worsen over the course of three to six months. The three primary symptoms are known as Hakim’s triad and include:
- Urinary incontinence.
- Difficulty walking
- Cognitive difficulties, including memory issues and emotional changes.
Between 50% and 75% of people with NPH exhibit all three symptoms concurrently.
While symptoms of NPH are similar to those experienced by dementia patients, NPH is, in some cases, reversible.
What causes NPH
There are two forms of NPH, primary (idiopathic) NPH and secondary NPH. Joel has not disclosed waht form of NPH he is suffering from.
Primary NPH accountrs for half of all cases and is attributed to age-realted issues that compromise the body’s ability to make, circulate and reabsorb CSF.
Evidence also suggests that NPH may be connected to degenerative brain conditions like Alzheimer’s disease and other forms of demntia. About 30% of people with NPH also have Alzheimer’s disease or a similar degenerative brain disease, according to Cleveland Clinic.
Secondary NPH is characterized by an underlying medical condition that affects the body’s ability to regulate CSF. These conditions include brain aneurysms and tumors, infections like encephalitis or meningitis, stroke and/or traumatic brain injuries.
How is NPH diagnosed
Because of the overlap between symtoms of dementia and NPH, diagnosing the conditon is difficult.
NPH is typically diagnosed by eliminating other possibilities and using a combination of methods including spinal tap, physcial and neurological examinaton, and diagnostic imaging. MRI scans are the most important tool in NPH diagnosis.
How is NPH treated
Unlike other dementia-like conditions, in some cases NPH is reversible.
Primary NPH is typically treated with a surgery and the implementation of a shunt. The shunt is characterized by two catheters that allow excess fluid to exit.
During surgery, a small hole is made in the skull and the catherter passes though it, exiting downwards and allowing CSF to drain into the chest or abdomen where it can be absorbed.
The type and efficacy of secondary NPH treatment is dependent upon the underlying cause.
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