Billy Joel’s Diagnosis Shines Light on Little-Known Brain Condition: Normal Pressure Hydrocephalus

Music icon Billy Joel’s recent diagnosis of Normal Pressure Hydrocephalus (NPH) has turned a spotlight on a neurological condition that, while often overlooked, is highly treatable.

At Baptist Health Miami Neuroscience Institute, Michael McDermott, M.D., Chief Medical Executive and distinguished neurosurgeon, offers expert insight into this condition—and how timely intervention can transform lives.

What Is Normal Pressure Hydrocephalus (NPH)?

Michael McDermott, M.D., neurosurgeon and the chief medical executive of Baptist Health Miami Neuroscience Institute.

 

Normal Pressure Hydrocephalus is a disorder in which excess cerebrospinal fluid (CSF) accumulates in the brain’s ventricles. While the pressure of the fluid remains within normal limits, the build-up creates pressure on surrounding tissues, disrupting brain function.

“NPH is one of those rare neurological conditions where we have the potential to reverse symptoms significantly with the right treatment, and gait and bladder control improve the most,” explains Dr. McDermott. “Unfortunately, it often masquerades as other common disorders like Alzheimer’s or Parkinson’s, which can delay the correct diagnosis.”

How Does NPH Develop?

NPH can arise without a clear cause, though it’s sometimes associated with:

• Head injuries
• Past brain surgeries
• Bleeding within the brain
• Central nervous system infections

It is most commonly seen in individuals over the age of 60.

“In South Florida, where we have a larger older population, we’re seeing this condition more frequently,” notes Dr. McDermott. “Fortunately, it's one of the few neurological disorders in this age group that is truly treatable.”

Recognizing the Signs and Symptoms

NPH is often marked by a trio of symptoms that families should be alert to:

• Gait disturbances – Difficulty walking, balance issues, or what’s often described as a ‘magnetic’ or ‘glue-footed’ gait, where it looks like patients are having trouble lifting their feet.
• Cognitive changes – Problems with memory, focus, or decision-making that resemble early dementia.
• Urinary symptoms – Including urgency, frequent urination, or incontinence.

“Families might first notice that a loved one has progressive difficulty with walking, has problems with bladder control and urgency incontinence, and may have mild cognitive impairment resulting in difficulty with daily tasks,” explains Dr. McDermott. “It’s easy to attribute these changes to aging, but they can be a red flag for something that is actually fixable.”

Is NPH a Form of Dementia?

No. While NPH can cause cognitive impairment, it is not a type of dementia—and that distinction is vital.

“Although symptoms might overlap with those seen in Alzheimer’s or other dementias, NPH is a completely separate diagnosis,” says Dr. McDermott. “That’s why it’s critical not to assume cognitive decline is untreatable.  The diagnosis is primarily based on history and physical and the triad of difficulty walking, urinary incontinence and mild cognitive decline are typical.  In many NPH cases, we can dramatically improve someone’s quality of life.”

How Is NPH Diagnosed?

The diagnostic process for NPH often starts with a simple visit to a primary care physician or neurologist.

“It usually begins with a gait assessment and a cognitive screening, such as the mini-mental status exam,” Dr. McDermott said. “If there's a concern, we move on to brain imaging—typically a CT or MRI—to confirm enlarged ventricles and rule out other structural causes. More comprehensive evaluations can involve removal of a large volume of cerebrospinal fluid by lumbar puncture with repeat analysis of gait metrics and neuropsychological testing.”