Impulse Control Disorders in Advanced Parkinson’s Disease With Dyskinesia: The ALTHEA Study Roberta Biundo, PhD, 1 Luca Weis, PhD, 1 Giovanni Abbruzzese, MD, PhD, 3 Giovanna Calandra-Buonaura, MD, PhD, 4,5 Pietro Cortelli, MD, PhD , 4,5 Maria Cristina Jori, MD, 6 Leonardo Lopiano, MD, PhD, 7 Roberto Marconi, MD, 8 Angela Matinella, MD, 9 Francesca Morgante, MD, PhD , 10 Alessandra Nicoletti, MD, 11 Tiziano Tamburini, MD, 12 Michele Tinazzi, MD, PhD, 13 Mario Zappia, MD, PhD, 14 Ruxandra Julia Vorovenci, MD, 15 and Angelo Antonini, MD, PhD 1,2 * 1 Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy 2 Department of Neuroscience (DNS), University of Padua, Padua, Italy 3 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa Genoa, Italy 4 Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy 5 I.R.C.C.S. Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy 6 Mediolanum Cardio Research, Milano, Italy 7 Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Torino, Italy 8 Unit a Operativa Complessa di Neurologia, Ospedale Misericordia, Grosseto, Italy 9 Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Italy 10 Dipartimento di Medicina Clinica e Sperimentale, Universit a di Messina, Messina, Italy 11 Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy 12 SC Neurologia - Ospedale S. Corona - ASL2 Savonese 13 Department of Neuroscience, Biomedicine and Motor Sciences, University of Verona, Italy 14 Clinica Neurologica I Policlinico Universitario, Catania, Italy 15 University of Medicine and Pharmacy “Victor Babes”; County Hospital, Department of Neurology, Timisoara, Romania ABSTRACT: Background: Impulse control disor- ders and dyskinesia are common and disabling complica- tions of dopaminergic treatment in Parkinson’s disease. They may coexist and are possibly related. The objectives of this study were to assess the frequency and severity of impulse control disorders in Parkinson’s disease patients with dyskinesia. Methods: The ALTHEA study enrolled 251 Parkinson’s disease patients with various degrees of dyskinesia severity from 11 movement disorders centers in Italy. Each patient underwent a comprehensive assessment including Unified Dyskinesia Rating Scale and the Questionnaire for Impulsive Compulsive Disorders in Parkinson Disease-Rating Scale. Results: There was an overall 55% frequency of im- pulse control disorder and related behaviors (36% were clinically significant). The positive patients were younger at disease diagnosis and onset and had higher Unified Dys- kinesia Rating Scale historical and total score (P 5 0.001 and P 5 0.02, respectively, vs negative). There was an increased frequency of clinically significant impulse con- trol disorders in patients with severe dyskinesia (P 5 0.013), a positive correlation between the questionnaire total score and dopamine agonist dose (P 5 0.018), and a trend with levodopa dose. Conclusions: More than half of Parkinson’s disease patients with dyskinesia have impulse control disorders and related behaviors, which are frequently clinically significant. Dopaminergic therapy total dose is associ- ated with their severity. Clinicians should carefully assess patients with maladaptive behaviors and dyski- nesia because they do not properly evaluate their motor and nonmotor status. V C 2017 International Parkinson and Movement Disorder Society Key Words: impulse control disorders and related behaviors; ICD; dyskinesia; self-awareness; levodopa; dopamine agonists ------------------------------------------------------------------------------------------------------------------------------ **Correspondence to: Angelo Antonini, Department of Neuroscience, Via Giustiniani 3, Padua Italy; angelo3000@yahoo.com Roberta Biundo and Luca Weis contributed equally to the article. Relevant conflicts of interest/financial disclosures: Authors declare no competing interests. Funding agencies: The study was supported by an unrestricted grant from the International Parkinson and Movement Disorders Society for Italian-language validation of the UDysRS to the Neureca Foundation Onlus. Received: 20 March 2017; Revised: 17 August 2017; Accepted: 23 August 2017 Published online 00 Month 2017 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mds.27181 RESEARCH ARTICLE Movement Disorders, Vol. 00, No. 00, 2017 1