When It’s Not Just Aging: Recognizing Normal Pressure Hydrocephalus (NPH)

Jul 15, 2025

When music legend Billy Joel revealed that he had been diagnosed with normal pressure hydrocephalus (NPH) in 2025, he did more than share a personal health update—he shed light on a little-known but potentially reversible neurological condition.

NPH occurs when excess spinal fluid builds up in the brain’s ventricles, compressing surrounding tissue. Prolonged compression can lead to brain damage. The good news is that NPH is usually treatable if diagnosed early.

Diagnosis Can Be Difficult

Although NPH affects of adults aged 65 and over, the symptoms are often mistaken for typical signs of aging, which can lead to missed or delayed diagnoses.

“Going to the doctor when something doesn’t feel right is important,” says Ramesh Grandhi, MD, MS, a neurosurgeon and NPH specialist at 91�鶹��ֱ��’s Clinical Neurosciences Center. “And it’s also important for doctors to listen when a patient says this doesn’t feel like just aging.”

The three main symptoms of NPH, often referred to as the “,” are:

Gait disturbances or difficulty walking
Cognitive changes that resemble dementia
Urinary incontinence, including the sudden urge to urinate or loss of bladder control

About 50-75% of people with NPH show all three symptoms, while of people with NPH have trouble predominantly with their gait. The symptoms of NPH usually start gradually, developing and worsening over three to six months.

Diagnosis and Treatment for NPH

The neurosurgery team at 91�鶹��ֱ�� works closely with radiology to confirm the characteristic signs of NPH through imaging. If NPH is suspected after clinical evaluations, then a lumbar puncture is performed to remove 40cc of spinal fluid.

Afterward, a comprehensive physical and cognitive evaluation of the patient is performed to assess any improvement. If the patient shows noticeable progress, they are likely a good candidate for a ventriculoperitoneal (VP) shunt, which has a strong track record of effectiveness for NPH. This surgical procedure diverts fluid from the brain to another area in the body.

Ongoing clinical trials are exploring a less invasive option known as the . Such advancements offer promising benefits, including reduced risk and faster recovery times.

Life After the Procedure

Most patients recover quickly after VP shunt surgery, typically spending just one night in the hospital and returning home the next day. Many can resume their regular routines within 48-72 hours. Since many people with NPH experience gait issues before surgery, working with a physical therapist soon after the procedure is crucial for improving walking, balance, and overall recovery.

Following early shunt placement, gait issues improve of cases, while improvements in urinary incontinence and cognitive function are seen in about 80% of cases.

“Many of my NPH patients who have undergone shunting are back to truly living and walking more confidently,” Grandhi says. “Everyone deserves the chance to live with the best quality of life possible.”