Music legend Billy Joel has long been known for his iconic performances and energetic stage presence. His recent concerts (July 2025) had to be cancelled due to balance problems and headaches. It was later revealed that Joel had been diagnosed with Normal Pressure Hydrocephalus (NPH), a lesser-known but serious neurological condition.
NPH is an often underrecognized neurological condition which affects the body’s balance system . Early detection of NPH can make a life-changing difference.
What Is Normal Pressure Hydrocephalus (NPH)?
The brain has cerebrospinal fluid (CSF) filled spaces called ventricles. When there is excess CSF build up, it leads to the gradual enlargement of the ventricles compressing the brain tissue. This condition is called Normal Pressure Hydrocephalus. The pressure can disrupt functions critical to balance, thinking, and bladder control.
While NPH typically affects adults over the age of 60, it’s often misinterpreted as Alzheimer’s, Parkinson’s, or simply aging causing many to miss out on treatment options that could dramatically improve their quality of life.
Know More About Balance
- What is a VEMP Test? Exploring the Vestibular Evoked Myogenic Potentials Test for Balance Disorders
- Vertigo and Balance Disorders in Children
- The Invisible Enemy Inside Your Ear: Understanding Vertigo and Its Impact on Balance
How Does NPH Affect Balance?
Balance is a complicated system of interactions involving the inner ear (vestibular system), visual input, proprioception (joint and muscles sensors) and the brain particularly the cerebellum and the frontal lobes that keeps you in balance.
In NPH, the bulging ventricles push on the white matter tracts and frontal lobes sections of the brain that are responsible for motor planning and coordination. The result? A gradual unsteadiness and mobility.
The common symptomatic manifestations relating to balance can be:
- Gait disturbance – The very first and most observable indication. Patients shuffle their steps and can look like they have their feet glued to the floor.
- Unsteadiness when turning – Being too hard may get you stumbling or falling.
- Backward falls – These are not only hazardous but sometimes unforeseen.
- Difficulty initiating walking – Like “freezing” in Parkinson’s disease.
What Should You Look Out For?
Doctors often use the classic triad “Wet, Wobbly, and Wacky” to describe the symptoms of NPH:
- Wobbly (Gait disturbance) – Shuffling, imbalance, frequent falls.
- Wet (Urinary issues) – Ranging from urgency to full incontinence.
- Wacky (Cognitive decline) – Memory loss, slowed thinking, or changes in personality.
The gait changes usually come first and are the most treatable so early detection is vital.
Neurological Signs and Tests That Help Detect NPH
In addition to clinical history and brain imaging, several neurological signs and tests can assist in diagnosing NPH:
- Magnetic gait – Short steps, wide base, and difficulty turning.
- “Timed Up and Go” (TUG) Test – Prolonged time to stand, walk, and return to a seated position indicates gait impairment.
- Frontal release signs – Primitive reflexes (like grasp reflex) that should not be present in healthy adults.
- Videonystagmography (VNG) – VNG could demonstrate abnormal saccades of the eye in most patients with NPH: increased latency and reduced velocity which indicate impairment of central brain pathways of ocular motor control. Such abnormalities are subtle and can favor a central (as opposed to peripheral) cause of imbalance.
- Brain imaging – MRI or CT is usually used to reveal disproportionately enlarged ventricles in the absence of cortical atrophy.
- CSF Tap Test – A small sample of cerebrospinal fluid is taken by a diagnostic lumbar puncture. Short-lasting walking or mental improvement later on offers strong evidence in favor of an NPH diagnosis.
NeuroEquilibrium provides various high-end tests, which assist in early diagnosis of Normal Pressure Hydrocephalus (NPH). These are videonystagmography (VNG) that tests abnormal eye motions associated with the problem of balance and the sensor-based gait and balance examination that can detect symptoms such as short shuffling steps or lack of turning ability. Timed Up and Go (TUG) and other tests done at the clinic to determine the capacity of a person to stand, walk, and sit well can show walking problems witnessed in NPH. Tests that are performed in the hospitals include MRI, CT scans, and the CSF tap test, and we can direct the patient to see whether these tests are necessary depending on the first test outcomes.
Why It Matters: A Treatable Cause of Balance and Memory Issues
Normal Pressure Hydrocephalus (NPH) is one of the few potentially reversible neurological conditions that can mimic Alzheimer’s or Parkinson’s disease, particularly in how it affects gait and cognition. The standard treatment involves the surgical insertion of a ventriculoperitoneal (VP) shunt, which helps drain excess cerebrospinal fluid and relieve pressure on the brain.
While not all patients experience a dramatic turnaround, many show significant improvement in walking, memory, and overall quality of life, especially when diagnosed and treated early.
Final Thoughts
The incident at the Billy Joel concert has helped shine a light on a condition that often goes unnoticed in the elderly. If you or a loved one is experiencing unexplained falls, balance issues, memory lapses, or urinary incontinence, don’t assume it’s just aging.
Early assessment is crucial. NeuroEquilibrium provides advanced diagnostic tools and expert neurological evaluations to help identify and manage conditions like NPH. With prompt intervention, Normal Pressure Hydrocephalus doesn’t have to be a final diagnosis, it can mark the beginning of a healthier, more balanced life.
FAQs
Why did Billy Joel cancel his concert?
Billy Joel cancelled his concert because of balance problems and headaches. It was subsequently disclosed that he was diagnosed with Normal Pressure Hydrocephalus (NPH), a neurological disorder which impairs balance, memory and bladder control.
What is Normal Pressure Hydrocephalus (NPH)?
NPH is a condition in which excess cerebrospinal fluid (CSF) is found in the ventricles of the brain and leads to their enlargement and compression of the surrounding brain tissue. Although the name is normal pressure, build up disrupts important brain functions like balance, walking and thinking.
What are the early signs of NPH?
The most frequent and the most apparent symptom is a gait change that is commonly called shuffling or magnetic gait. Other symptoms include frequent falls, loss of ability to turn or start to walk, memory problems and urgency and incontinence of urine.
How is NPH diagnosed?
Medical practitioners combine a clinical assessment, MRI or CT brain scan, gait analyses such as the Timed Up and Go test, and occasionally a CSF Tap Test. Eye movement tests such as Videonystagmography (VNG) can also be useful, in that it can detect central balance problems.
Can NPH be treated?
Yes, NPH is among the few reversible causes of balance and memory problems among older adults. Surgical insertion of a shunt to remove the excess fluid is most commonly used and can greatly alleviate the symptoms provided it is done early.
