Billy Joel canceled all 17 concerts planned for 2025 after recently diagnosing normal pressure hydrocephalus (NPH).
This brain disease is caused by an excessive accumulation of Liquor in the brain chambers and leads to a number of cognitive and physical problems. This includes in particular for gait, coordination and bladder weakness.
In an explanation, Joel’s team announced that the musician had problems with his “hearing, vision and balance”. He now wanted to undergo “special physiotherapy” during his recovery. “I’m sincerely sorry to disappoint our audience,” said Joel himself, “and thank you for your understanding.”
Who is often affected by normal pressure hydrocephalus?
NPH affects adults aged 65 and over, and the number of people who have to deal with this disease is estimated at around 700,000. Dr. Charles Matouk, neurosurgeon and professor at the Yale School of Medicine, to Rolling Stone, however, told that Nph is probably “much more often than we think. It is simply diagnosed in this country far too rarely.”
The cognitive and physical impairments caused by NPH often cause the disease to be confused with other neurodegenerative diseases such as Alzheimer’s and Parkinson’s. In contrast to these diseases, however, there is a relatively simple way to identify NPH and treat some of the most serious symptoms.
“NPH itself does not lead to death like cancer or a heart attack, but it significantly affects the quality of life,” explains Matouk. In the event of early detection and treatment, however, one could “significantly improve the condition of those affected,” he adds.
How does the disease come about?
What exactly leads to the accumulation of excess liquid is still unclear. It is currently being examined whether there is a genetic disposition for the disease, says Matouk. But there is currently no clear genetic marker for it. It is known that NPH is often triggered by physical trauma that can be serious or slightly.
For example, an older person can show signs of slowing down until a fall triggers a “sudden decay” of their condition.
It is unclear when exactly Joel received his diagnosis, but towards the end of his last concert on February 22, he fell flat on his back after he had thrown his microphone tripod to a crew member. Joel was able to get up again and end his performance. A month later, however, he announced that he would postpone future shows. The reason: after an “illness” that required physiotherapy, he had to undergo surgery.
These are early symptoms
Since early detection of NPH is often crucial for treatment, Matouk calls two very common early symptoms. One is the inability to get up from a deep sofa or armchair. This applies in particular to those without armrests where you can support yourself. The other is a severe deterioration in the manuscript.
Interestingly, the inability to get up from the armchair is not a problem of muscle strength, and tremors are not responsible for the deterioration of the manuscript. In both cases, according to Matouk, it is a coordination problem caused by the NPH.
As far as the cognitive restrictions caused by normal pressure hydrocephalus, they are “much milder” according to Matouk than with Alzheimer’s or dementia. Nevertheless, they can significantly affect a person’s lives. “It’s more like that [NPH-Patienten] are apathetic, more distant and less shared in life, ”explains Matouk.
This is how NPH is diagnosed
Since there is not a single diagnostic test for recognizing NPH, doctors rely on these clinical signs and on CAT scans or MRI shots of the brain to determine where liquid has accumulated.
However, the final diagnosis is only made after doctors have carried out a lumbar puncture. The fluid is removed from a person’s back and observes whether their condition improves. “And patients can often recover within an hour,” says Matouk.
Lumbar puncture helps with diagnosis
If a lumbar puncture leads to an NPH diagnosis, the patient is an option for surgery, which is referred to as a ventricular shunt and makes the puncture permanently. You drill a hole in the patient’s head, attach a hose and lead it to part of the body under the skin, which can naturally absorb the excess liquid.
Currently, clinical studies are currently on a far fewer invasive, more easily accessible treatment, in which the same is achieved by a small puncture in the bar or in the thigh.
These methods can lead to a significant improvement for patients, especially in terms of the physical symptoms of normal pressure hydrocephalus, as Billy Joel also experiences. However, they are not a complete healing. Matouk contradicts the view that NPH is a kind of reversible dementia: “Even with treatment, the memory problems do not improve nearly as strong as the gait and the bladder control.”
Normal pressure hydrocephalus: Can Billy Joel soon appear?
Whether this means that someone like Billy Joel can reappear is an open question. Matouk reports on a guitarist he treated. He could no longer play in a local jazz band with friends.
Finally, according to Matouk, “he could play again. I would not say that he played as well as before. But he definitely played well enough to return to the band. And that meant a lot.”