Honestly, it felt like the end of an era when the news broke. In May 2025, the "Piano Man" himself, Billy Joel, had to pull the plug on his touring schedule. For a guy who seemed like he’d be playing Madison Square Garden until the sun burned out, it was a shock. Fans started whispering immediately. Was it dementia? Was it a stroke? The reality is actually something most people have never even heard of: Normal Pressure Hydrocephalus, or NPH.
It’s a mouthful.
Basically, your brain is floating in cerebrospinal fluid. Usually, that fluid flows in and out, keeping things cushioned. With NPH, the fluid builds up. It doesn't necessarily spike the pressure inside your skull to crazy levels—hence the "normal pressure" part of the name—but it stretches the brain's ventricles. Imagine a balloon inflating slowly inside a tight box. Eventually, something has to give. For Billy Joel, that "something" was his balance and his ability to stay on his feet.
The Night the Music Almost Stopped
Back in February 2025, Joel took a nasty spill during a show at the Mohegan Sun Arena in Connecticut. He was doing his thing, spinning the mic stand during "It's Still Rock and Roll to Me," and he just... went down. He finished the set, because he's Billy Joel, but that fall was the smoking gun. His booking agent, Dennis Arfa, later admitted they noticed the balance issues then, but didn't realize how deep the rabbit hole went.
The diagnosis came shortly after.
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Normal Pressure Hydrocephalus is often called the "great mimic." Why? Because it looks exactly like Alzheimer’s or Parkinson’s to the untrained eye. You get the "wacky, wobbly, and wet" symptoms: cognitive fog, walking like your feet are glued to the floor, and bladder issues. It’s scary stuff. When Billy Joel spoke to Bill Maher on the Club Random podcast in July 2025, he was pretty blunt about it. "My balance sucks," he said. He described the sensation as being on a rocking boat.
Why NPH is Different from Other Brain Diseases
Most people hear "brain disorder" and assume it's a death sentence. It’s not. Unlike Alzheimer’s, NPH is actually treatable, and in some cases, the symptoms can be reversed.
Doctors usually go in and perform a procedure to install a VP shunt. It’s a tiny tube that drains that excess fluid from the brain down into the abdomen where the body can just absorb it. It’s high-stakes plumbing. While Joel’s team hasn't shared every single surgical detail, they’ve been clear that he’s been deep in physical therapy.
It Isn't Just One Thing
You can't really talk about what disease does Billy Joel have without looking at the wear and tear of fifty years on the road. The man’s body has been through the ringer.
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- The Hips: Back in 2010, he had a double hip replacement. He joked with Howard Stern that he was "twice as hip" as he used to be, but the reality was years of jumping off pianos and stomping on stages had obliterated his joints.
- The Voice: He’s had bouts of severely inflamed vocal cords, notably around 2002, which forced tour cancellations and sent him into a bit of a tailspin.
- Mental Health: This is the part people forget. In his new documentary, Billy Joel: And So It Goes, he’s incredibly open about his past suicide attempts in his early 20s. He once drank a bottle of furniture polish (Lemon Pledge, specifically) because he felt like a "homewrecker" after an affair with his bandmate’s wife. He survived, obviously, but that kind of deep-seated depression doesn't just vanish.
He’s also been open about his history with alcohol. For years, he used it to self-medicate for depression, especially after the trauma of 9/11. He checked into the Betty Ford Center in 2005 after an ultimatum from his then-wife, Katie Lee. Interestingly, when he got the NPH diagnosis, his first thought was, "Is this because of the drinking?" He’d been sober for a few years by then, but the guilt was still there.
The Road Back to the Piano
So, is he done? Not quite.
Just recently, in early 2026, Joel made a surprise appearance in Florida, hopping on stage with a tribute band called Turnstiles to play a couple of songs. He wasn't doing backflips, but he was there. His agent says his "DNA is music," and he's still obsessed with it even when he’s grounded.
The recovery for NPH is a marathon, not a sprint. Physical therapy is a massive part of the equation because you have to "relearn" how to trust your legs. Even with a shunt, the brain needs time to adjust to the new pressure levels.
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What You Should Take Away
If you or someone you love is over 60 and suddenly starts walking like a penguin or getting "foggy," don't just assume it's old age. NPH is frequently misdiagnosed as permanent dementia.
- Get a second opinion: If symptoms look like Parkinson's but "feel" different, ask about a lumbar puncture test.
- Prioritize balance: Joel’s fall was the trigger for his diagnosis. Don't ignore stumbles.
- Watch for the "Hallmark Three": Difficulty walking, memory lapses, and urinary urgency.
Billy Joel’s battle with Normal Pressure Hydrocephalus has actually done a lot of good for public awareness. It’s a weird, rare condition that now has a very famous face attached to it. He’s "okay," as he told People magazine, but he’s definitely in a new chapter where the stage lights are a little dimmer and the focus is on just staying upright.
If you're tracking his recovery, the best thing to look for isn't a new tour announcement—it's those small, unannounced guest appearances. That's where the real healing is happening. You can stay updated on his progress through his official site, but for now, the Piano Man is mostly playing for himself and his family.
To help someone you know who might be struggling with similar gait or memory issues, you should look into the Hydrocephalus Association resources. They provide specific checklists for NPH that you can take to a neurologist to ensure an accurate diagnosis before assuming the worst.
Next Step: I can provide a detailed breakdown of the specific "lumbar drain trial" doctors use to confirm an NPH diagnosis if you're looking for more medical specifics.