Normal pressure hydrocephalus (NPH) is often called the “treatable dementia,” yet many people had never heard of it until singer-songwriter Billy Joel announced his diagnosis in 2025. Despite affecting up to 5% of adults over age 80, it is frequently mistaken for normal aging, Alzheimer’s disease or Parkinson’s disease.

In NPH, cerebrospinal fluid—the clear fluid that cushions and supports the brain—does not drain properly. As the fluid accumulates, the system of four cavities in the brain (called ventricles) enlarge and begin compressing nearby brain tissue. Although the measured pressure inside the skull may appear “normal,” the effects on brain function are anything but.

NPH symptoms can sometimes improve with treatment if recognized early enough.

Walking becomes a mystery

The earliest and most recognizable symptom of NPH is often a change in walking. People may take slow, short, shuffling steps and appear unsteady, almost as if their feet are “stuck” to the floor. This pattern is sometimes called a magnetic gait.

Unlike in Parkinson’s disease, people with NPH don’t usually have tremors and muscle rigidity. Instead, the problem lies in the brain circuits responsible for initiating and coordinating movement. Walking, something that’s normally automatic, suddenly requires conscious effort.

Thinking feels slower

NPH can also affect cognitive function, but not always in the way people expect. Many people experience slowed thinking rather than severe memory loss. Difficulty focusing, a lack of motivation or trouble multitasking are also common symptoms.

A useful way to think about it is this: The information may still be there, but the brain has difficulty accessing it efficiently. The enlarged ventricles disrupt the brain networks responsible for attention, planning and executive function, making mental processing feel slower.

The symptom no one talks about

The third part of the classic NPH triad is urinary urgency or incontinence. While this symptom is often dismissed as part of aging, it’s actually happening from disruption of the same brain networks involved in movement and cognition.

Normally, the brain acts as a “brake system,” helping suppress the urge to urinate until the appropriate time. In NPH, those pathways become impaired, making bladder control more difficult.

The challenge of NPH: Each symptom alone can seem unrelated or easily explained away. But together, they tell a different story, one that may point toward a neurological condition that is not only underrecognized, but potentially treatable.

If you saw these three symptoms in someone you know, would you recognize the pattern? Maybe now you will.