Alzheimer's copycat? The real culprit behind Billy Joel's health scare
Key Takeaways
Industry Buzz
"[It is a] little known but often reversible brain condition that mimics Alzheimer's disease. One of my patients, 72 years old, was told he had Alzheimer's disease, [but] after a simple shunt procedure to relieve [...] pressure on his brain, he fully recovered his memory and his life came back." — Daniel G. Amen, MD, psychiatrist
Legendary musician Billy Joel, 76, has been diagnosed with normal pressure hydrocephalus (NPH), a condition characterized by the accumulation of cerebrospinal fluid in the brain's ventricles. []
This diagnosis has led to the cancellation of all his upcoming concerts as he focuses on treatment and recovery.
Understanding NPH
NPH is a neurological disorder that results from the buildup of cerebrospinal fluid (CSF) in the brain's ventricles, leading to increased pressure that can affect brain function.
Despite the term "normal pressure," the condition can cause significant symptoms, including difficulties with walking, balance, cognition, and bladder control. []
Joel's diagnosis followed a fall during a February 2025 concert, which raised concerns about his health. Subsequent medical evaluations confirmed NPH, prompting the decision to cancel his tour dates to prioritize his health. []
Related: This common disorder may be the surprising culprit behind memory problemsTreatment and prognosis
Treatment for NPH often involves surgical intervention, such as the placement of a shunt to drain excess CSF and alleviate pressure. Joel is currently undergoing physical therapy and is under close medical supervision. []
According to the Hydrocephalus Association, physical therapy for those with NPH may include balance, strength, and walking exercises, as the condition can cause poor balance and irregular gait. []
Why is NPH commonly misdiagnosed as Alzheimer's?
"Normal pressure hydrocephalus [is a] little known but often reversible brain condition that mimics Alzheimer's disease. One of my patients, 72 years old, was told he had Alzheimer's disease and needed to get his affairs in order, but a spec scan told a different story: NPH. And after a simple shunt procedure to relieve the pressure to decrease the fluid that was putting pressure on his brain, he fully recovered his memory and his life came back," said psychiatrist Daniel G. Amen, MD, in an Instagram Reel.
NPH is often misdiagnosed as Alzheimer's disease—and even Parkinson's—because the early symptoms overlap significantly. [] Both NPH and Alzheimer’s can cause:
Memory problems
Slowed thinking
Confusion
However, NPH usually causes less severe memory loss than Alzheimer’s at onset. In NPH, the cognitive impairment is more about executive dysfunction (eg, planning and problem-solving) than memory encoding and recall.
Additionally, both conditions typically affect people over 60, and symptoms may come on slowly, which leads many clinicians and families to assume it's "just aging" or even dementia.
Alzheimer’s is also much more common and well-known than NPH. Many primary care physicians and even some neurologists may not think to order brain imaging early in the diagnostic process, but a CT or MRI can reveal ventricular enlargement without significant cortical atrophy—key for diagnosing NPH.
Implications for medical professionals
Joel's public disclosure of his NPH diagnosis brings attention to a condition that is often underdiagnosed or misdiagnosed, particularly in older adults. []
Medical professionals should be aware of NPH's symptoms and consider it in differential diagnoses when patients present with gait disturbances, cognitive decline, and urinary incontinence. Early detection and intervention can significantly improve patient outcomes.
As Joel focuses on his health, the medical community can use this opportunity to raise awareness about NPH and advocate for comprehensive evaluations in patients exhibiting related symptoms.
Related: This sleep condition looks like early Alzheimer's—and it triples your dementia risk