What Is the Brain Disorder Forcing Billy Joel to Cancel His Tour? A Medical Expert Explains

Billy Joel has canceled all 17 of his scheduled concerts for 2025 after revealing a recent diagnosis of normal pressure hydrocephalus (NPH), a neurological condition that can significantly affect mobility, balance, and cognition.

NPH is caused by a buildup of cerebrospinal fluid in the brain’s ventricles. This accumulation creates pressure that impacts essential brain functions, particularly those related to walking, coordination, and bladder control.

In a statement, Joel’s team noted that he had been experiencing problems with his “hearing, vision, and balance,” and confirmed that the singer is “undergoing specific physical therapy” as part of his recovery process.

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

NPH primarily affects adults aged 65 and older, and estimates suggest that approximately 700,000 people in the United States may be living with the condition. However, Dr. Charles Matouk, a neurosurgeon and professor at the Yale School of Medicine, told Rolling Stone that the actual number could be much higher.

“NPH is probably much more common than we think,” he said. “It’s just profoundly underdiagnosed in this country.”

One of the reasons NPH is often missed is that its symptoms can mimic those of more well-known neurodegenerative diseases like Alzheimer’s and Parkinson’s. While both of those conditions are chronic and progressive, NPH has a unique feature: many of its symptoms can be reversed or significantly improved if diagnosed and treated early.

“NPH, in and of itself, is not going to kill you like cancer or a heart attack,” said Matouk. “But it is going to decrease your quality of life.” He added that when caught early, “You can significantly improve people.”

Billy Joel has canceled all 17 of his scheduled concerts for 2025 after revealing a recent diagnosis of normal pressure hydrocephalus (NPH)

Billy Joel Official

The exact cause of NPH remains unknown. While researchers are exploring whether genetics may play a role, Matouk stated that there is currently no definitive genetic marker.

What doctors do know is that physical trauma, even relatively minor, can sometimes trigger the condition. For example, an older adult who already seems to be slowing down might experience a dramatic decline after a fall.

It has not been confirmed exactly when Joel received his diagnosis. However, at his concert on February 22, he fell flat on his back after tossing his microphone stand to a crew member.

He managed to get back on his feet and finish the performance, but a month later, he postponed upcoming shows due to what was described as a “medical condition” that required surgery and physical therapy.

Understanding NPH's Impact

Normal pressure hydrocephalus (NPH) is often overlooked, but experts like Dr. David Perlmutter, a renowned neurologist, emphasize its significant impact on daily functioning. He notes that many patients experience symptoms that mimic other disorders, leading to misdiagnosis. The fluid buildup in the brain can lead to gait disturbance and cognitive decline, emphasizing the need for awareness among healthcare providers.

As Dr. Perlmutter states, recognizing early signs like unexplained falls or memory issues can facilitate quicker diagnosis and treatment, ultimately improving quality of life.

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

Billy Joel Official

Dr. Matouk explained that catching NPH early can make a major difference. Two of the earliest and most recognizable signs are surprisingly specific.

One is difficulty getting up from a soft chair or deep couch, especially when the seat lacks armrests. The other is a sudden decline in handwriting quality. Importantly, these are not symptoms of muscle weakness or tremors, but rather issues with coordination that stem directly from NPH.

In terms of cognitive symptoms, Matouk emphasized that NPH-related decline tends to be “much more mild” than what is seen in Alzheimer’s or other forms of dementia. “It’s more that [NPH patients] are apathetic, they’re more detached, less engaged in life,” he said.

Diagnosing NPH is not simple. There is no single test that can confirm it. Doctors typically rely on a combination of clinical observations and brain imaging, such as CAT scans or MRIs, to detect fluid buildup. However, a true diagnosis often comes only after a spinal tap. In this procedure, cerebrospinal fluid is drawn from the patient’s back, and the response is monitored.

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

Dr. Matouk explained that catching NPH early can make a major difference. Two of the earliest and most recognizable signs are surprisingly specific.

One is difficulty getting up from a soft chair or deep couch, especially when the seat lacks armrests. The other is a sudden decline in handwriting quality. Importantly, these are not symptoms of muscle weakness or tremors, but rather issues with coordination that stem directly from NPH.

In terms of cognitive symptoms, Matouk emphasized that NPH-related decline tends to be “much more mild” than what is seen in Alzheimer’s or other forms of dementia. “It’s more that [NPH patients] are apathetic, they’re more detached, less engaged in life,” he said.

Diagnosing NPH is not simple. There is no single test that can confirm it. Doctors typically rely on a combination of clinical observations and brain imaging, such as CAT scans or MRIs, to detect fluid buildup. However, a true diagnosis often comes only after a spinal tap. In this procedure, cerebrospinal fluid is drawn from the patient’s back, and the response is monitored.

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

Many healthcare professionals advocate for a more proactive approach to managing NPH. Dr. Michael Klaper, a physician specializing in holistic health, suggests that lifestyle modifications can play a significant role in managing symptoms. He recommends engaging in regular physical activity tailored to one's ability, which can enhance mobility and cognitive function.

Incorporating cognitive exercises and maintaining a balanced diet rich in omega-3 fatty acids is also vital. These measures, according to Dr. Klaper, can help mitigate some challenges presented by NPH, promoting overall well-being.

Understanding NPH is crucial for both patients and healthcare providers, as early intervention can significantly improve outcomes. Research from the National Institutes of Health indicates that proper diagnosis and timely treatment can prevent further cognitive decline and enhance mobility.

Moreover, lifestyle changes, as highlighted by experts like Dr. Klaper, can empower patients to take charge of their health. Fostering a supportive environment, encouraging open communication about symptoms, and emphasizing self-care can create a holistic approach to managing NPH effectively.