“Piano Man” singer Billy Joel, 76, mentioned Friday that he’s bowing out of his 2025 tour after being identified with the mind situation regular stress hydrocephalus (NPH).
Latest dwell performances “lead to problems with hearing, vision, and balance,” Joel mentioned on Instagram.
He was suggested by his physician to chorus from performing whereas he undergoes therapy and restoration.
The “New York State of Mind” performer postponed a number of tour dates in March on account of a “medical condition” that pressured him to “undergo physical therapy under the supervision of his doctors” following an onstage fall in February.
“I’m sincerely sorry to disappoint our audience, and thank you for understanding,” Joel mentioned Friday in response to the newest spherical of cancellations.
What’s NPH?
Hydrocephalus happens when cerebrospinal fluid (CSF) builds up within the mind, disrupting cognitive functioning.
CSF gives vitamins to and removes waste merchandise from the mind whereas cushioning it and the spinal wire from pressure.
Usually, adults have 5 fluid ounces of CSF, with the physique continuously producing, circulating and reabsorbing the fluid to maintain that degree fixed.
However when the physique fails to flow into or reabsorb CSF accurately, it may well accumulate.
In NPH, this buildup is often gradual sufficient that the stress contained in the cranium will increase, however stays inside regular vary. The fluid runs into the mind’s ventricles, which may maintain a few of the overflow.
“NPH is a type of hydrocephalus that is seen typically in older people,” Dr. Matthew Potts, affiliate professor of neurological surgical procedure, radiology and neurology at Northwestern College Feinberg College of Drugs, informed The Publish.
“The fluid builds up, and it doesn’t necessarily affect the pressure in the brain — hence the ‘normal pressure’ part — but it still affects the brain.”
If CSF retains accumulating, the mind begins to compress. If this compression lasts too lengthy, everlasting harm can happen.
NPH is most typical in seniors, with the common age of prognosis being 70.
NPH impacts about 0.2% of individuals between the ages of 70 and 80 and about 6% of individuals over 80. It’s very uncommon in folks beneath 65.
What are the signs?
NPH signs start progressively and worsen over the course of three to 6 months. The three major signs are often called Hakim’s triad and embody:
- Urinary incontinence
- Problem strolling
- Cognitive difficulties, together with reminiscence points and emotional adjustments
Between 50% and 75% of individuals with NPH exhibit the three signs on the similar time.
“The three classic symptoms of NPH — cognitive/memory problems, issues with balance/gait and urinary incontinence — are very similar to a lot of other things that can happen in older adults,” Potts mentioned.
“So, some people may be diagnosed with dementia even though it’s NPH. If it happens that it’s caused by NPH, we have a treatment for it.”
What causes NPH?
There are two types of NPH — major (idiopathic) NPH and secondary NPH. Joel has not disclosed the type of NPH he has.
Major NPH accounts for half of all instances and is attributed to age-related points that compromise the physique’s capacity to make, flow into and reabsorb CSF.
Proof means that NPH could also be linked to degenerative mind situations like Alzheimer’s illness and different types of dementia. About 30% of individuals with NPH even have Alzheimer’s or the same situation, in line with Cleveland Clinic.
Secondary NPH is characterised by an underlying medical situation that impacts the physique’s capacity to control CSF. These situations embody mind aneurysms and tumors, infections like encephalitis or meningitis, stroke and/or traumatic mind accidents.
How is NPH identified?
NPH is a worsening situation that impacts cognition, which means many individuals don’t know they’ve it. That makes early detection tough and early therapy vital.
Due to the overlap between signs of dementia and NPH, diagnosing NPH is difficult.
Medical doctors are inclined to get rid of different potentialities utilizing a mix of strategies, together with spinal faucet, bodily and neurological examination and diagnostic imaging.
“There is not one test that says ‘Yes, this is NPH.’ For some patients, fluid will build up and a brain scan (CT scan or MRI) might show it, but that doesn’t mean it’s NPH,” Potts mentioned.
“Ultimately, it comes down to do the symptoms really fit with the picture physicians see?”
How is NPH handled?
Major NPH is usually handled with surgical procedure and the implementation of a shunt. One finish of the shunt goes into the CSF, whereas the opposite finish often goes to the stomach to empty the surplus fluid.
Neurosurgeons typically do a check simulating what would occur in the event that they drained the fluid, Potts mentioned.
“We place a needle into the lower back to drain the fluid (called a lumbar puncture or spinal tap), which acts as a tiny temporary drain that helps the fluid slowly exit the body through their skin over a few days to simulate if they had a shunt,” he added.
“We ask: Do they get better? If over a few days their balance and gait improve, we say, if we place a shunt, you’ll probably get better. If not, we say it might not be NPH.”
The kind and efficacy of secondary NPH therapy depend upon the underlying trigger.
NPH prognosis
Not like different dementia-like situations, NPH is usually reversible, with a constructive prognosis tied to early prognosis and therapy.
The longer NPH goes undiagnosed, the extra seemingly the rise in stress will end in extreme or everlasting mind harm.
Mobility points, cognitive difficulties and urinary incontinence are seemingly to enhance with therapy.
