Is Billy Joel’s Brain Disorder the Same as Dementia?

Legendary musician Billy Joel recently cancelled his current tour after being diagnosed with normal pressure hydrocephalus (NPH), which is also known as water on the brain.  

This rare condition can develop if the flow of cerebrospinal fluid (CSF) is blocked. CSF helps absorb shock, protecting the brain and spinal cord. It also provides the brain and spinal cord with nutrients and removes waste. Each day, the brain ventricles produce enough CSF to fulfill its functions. The fluid is then reabsorbed into the blood.  

If the normal flow of CSF is compromised or not reabsorbed, CSF will accumulate in the ventricles, enlarging them to the point that they’re pressing against brain tissue, potentially damaging the brain. It’s thought that NPH causes up to five percent of dementia cases, according to Yale Medicine.    

Types of NPH  

NPH is classified as idiopathic (or primary) or symptomatic (or secondary). Idiopathic has no known cause, whereas symptomatic may be traced back to issues such as traumatic brain injury, radiation, brain infection, brain bleed, brain tumor, meningitis or stroke.

NPH vs Dementia

NPH usually affects adults in their 70s but often goes undetected. Experts suspect that 700,000 Americans have NPH, but less than 20 percent have been diagnosed, according to Yale Medicine. Moreover, NPH is often mistaken for a neurogenerative disease, as its symptoms mimic those of Alzheimer’s and Parkinson’s diseases. NPH patients often experience:  

• Cognitive impairment, including forgetfulness and confusion
• Walking difficulties and trouble lifting legs
• Poor balance and falling
• Loss of bladder control
• Depression and mood changes    

In Joel’s case, he was reportedly having problems with vision, hearing and balance, even falling on stage while performing at the Mohegan Sun in Connecticut last February.

Despite NPH resembling neurodegenerative diseases, the condition is quite different. In brain disorders like dementia, the brain tissue shrinks, resulting in a loss of brain cells and connections between cells that maintain cellular communication. While it’s part of the normal aging process, it’s most often associated with Alzheimer’s disease and other forms of dementia. When brain shrinkage occurs, brain ventricles appear larger than normal. However, in NPH, brain ventricles have enlarged, but the brain tissue may not have shrunk.  

Another difference is that NPH may be reversible. Your chances of reversing the condition are better if you’re diagnosed early and treated quickly. The longer it takes to get treated, the greater the risk of permanent brain damage.  

Symptoms develop slowly and are sometimes overlooked as normal aging or mistaken for Alzheimer’s or Parkinson’s or another condition such as arthritis, peripheral neuropathy, inner ear disorders and spinal conditions. To complicate matters, about 33 percent of people with NPH also have dementia.

Tips to Help You Lower Your Risk for NHP

The following tips from Cleveland Clinic may help maintain brain health, lowering your risk for NPH.

• Manage chronic conditions. Health issues like high blood pressure, high cholesterol and diabetes can damage your blood vessels, ultimately affecting your overall brain health. They also can raise the likelihood of aneurysms and bleeding, raising your risk for NPH.  
• Protect your head. Traumatic brain injuries are linked to NPH. Wear helmets and other appropriate safety gear when participating in activities that raise the risk of falling like cycling and skating.    
• Treat infections. Brain infections such as encephalitis or meningitis should be treated, as they have a clear connection to brain health. But you also should take eye and ear infections seriously as it’s possible for them to spread to the brain.  

Most importantly, develop a strong relationship with your primary care physician. This is one reason why MDVIP-affiliated practices are much smaller than traditional primary care practices. Appointments last as long as needed, enabling doctors to get to know you and your health history.  

The MDVIP Wellness Program also includes screenings that may help pick up on NPH including emotional health, gait analysis, vision and hearing. Your MDVIP-affiliated physician can use the results from these screenings to develop a personalized wellness program for you and refer you to specialists as needed.  

If you don’t have a primary care physician, consider partnering with an MDVIP-affiliated physician. MDVIP doctors have the time to work with you and develop a wellness plan that can help you eat healthier. Find a physician near you and begin your partnership in health »