What’s the Brain Disorder Forcing Billy Joel to Cancel His Tour? An Expert Explains

Billy Joel has canceled all 17 shows he had scheduled for 2025 after announcing a recent diagnosis of Normal Pressure Hydrocephalus (NPH). 

This brain disorder is caused by the accumulation of too much cerebrospinal fluid in the brain’s ventricles, leading to a host of cognitive and physical problems, especially gait, coordination, and bladder control issues. In a statement, Joel’s team said the musician had been having problems with his “hearing, vision, and balance,” and that he’s “undergoing specific physical therapy” as he recovers. 

“I’m sincerely sorry to disappoint our audience,” Joel himself said, “and thank you for understanding.”

NPH affects adults aged 65 and over, and best estimates put the number of people battling the condition at about 700,000. But Dr. Charles Matouk, a neurosurgeon and professor at the Yale School of Medicine, tells Rolling Stone that NPH is probably “much more common than we think. It’s just profoundly underdiagnosed in this country.” 

The cognitive and physical impairments caused by NPH often lead it to be confused with other neurodegenerative diseases like Alzheimer’s and Parkinson’s. But unlike those diseases, there’s a fairly straightforward way to detect NPH and address some of its most debilitating symptoms. 

“NPH, in and of itself, is not going to kill you like cancer or a heart attack, but it is going to decrease your quality of life,” Matouk says. But if detected and treated early, he adds, “You can significantly improve people.”

The exact cause of NPH — what prompts that build-up of excess fluid — remains a mystery. There’s ongoing research into whether there’s a genetic predisposition to the condition, Matouk says, but at the moment, doctors don’t have a solid genetic marker for it. What is known is that NPH is often triggered by physical trauma, whether major or minor. For instance, an older person may be showing signs of slowing down, only for a fall to prompt a “precipitous decline” in their condition.

(It’s unclear exactly when Joel received his diagnosis, but near the end of his last concert on Feb. 22, he fell flat on his back after throwing his microphone stand to a crew member. Joel was able to get back on his feet and finish his set, but a month later, he announced that he was postponing future shows after undergoing surgery for a “medical condition” that required physical therapy.)

Because catching NPH early can often be key to treating it, Matouk notes two very common early signs. One is an inability to get out of a deep couch or chair, especially one that doesn’t have arms to push off of; the other is a sharp decline in handwriting quality. Interestingly, the inability to get out of the chair is not a strength issue, and tremors do not cause the decline in handwriting. In both instances, Matouk says, it’s a coordination issue caused by the NPH. 

As for the kind of cognitive decline caused by NPH, it’s “much more mild” than Alzheimer’s or dementia, Matouk says. But it’s still capable of disrupting a person’s life. “It’s more that [NPH patients] are apathetic, they’re more detached, less engaged in life,” Matouk says. 

With no single diagnostic test available to detect NPH, doctors rely on these pieces of clinical evidence, along with CAT scans or MRIs of the brain, to show where fluid has built up. But the final diagnosis doesn’t come until after doctors perform a spinal tap — drawing fluid from a person’s back and then seeing if they get better. 

“And patients can often get better in like an hour,” Matouk says.

If a spinal tap leads to a NPH diagnosis, a patient then becomes a candidate for a surgery called ventricular shunting, which effectively makes the tap permanent. It involves drilling a hole in a person’s head, affixing a tube, and then threading that tube under a person’s skin to a part of the body that can naturally absorb that excess fluid. Clinical trials are also underway for a far less invasive, more accessible treatment that would achieve the same thing by tapping into blood vessels via a small puncture in the thigh or groin.

These procedures can lead to significant improvements for patients, especially when it comes to addressing the physical symptoms of NPH. But they’re not an outright cure, and Matouk pushes back against the perception of NPH as a kind of reversible dementia, saying, “Even with treatment, the memory problems are not improved to nearly as great an extent as gait and bladder control.”

Whether this means someone like Joel could reach a place where he’s able to perform again is an open question. Matouk, for his part, says he once treated a guitarist patient who was temporarily sidelined from playing in a local jazz band with friends. 

Eventually, Matouk says, “He was able to get back. I wouldn’t say he was able to play as he [once] did, but he was certainly able to play well enough that he could rejoin the band. And that had a lot of meaning for him.”