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Such knowledge is crucial to identify modifiable factors promoting everyday life with SCA and attenuating HRQoL decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study is to assess HRQoL progression and identify factors affecting SCA patients\u2019 HRQoL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Longitudinal data (three-year follow-up) of 310 SCA patients of the European SCA3\/Machado-Joseph-Disease Initiative (ESMI) (2016-2022) and 525 SCA patients (SCA1, SCA2, SCA3 or SCA6) of the EUROSCA natural history study cohort (2006\u20132015) were assessed. Both large cohort studies share standardized assessments of clinical measures, SARA, INAS, PHQ-9, and HRQoL (EQ-5D-3L). The association between HRQoL and clinical measures was assessed by Spearman Correlation (r\n                      <jats:sup>s<\/jats:sup>\n                      ). Multivariable panel regression models were performed to evaluate the impact of patients\u2019 socio-demographics, age of onset, SCA type and body mass index (BMI), and clinical measures on HRQoL progression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HRQoL significantly decreased over one (\u2212 0.014,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.095), two (\u2212 0.028,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), and three years (\u2212 0.032,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002). Ataxia severity and mental health strongly correlated with HRQoL (r\n                      <jats:sup>s<\/jats:sup>\n                      <jats:sub>SARA<\/jats:sub>\n                      = \u2212 0.589; r\n                      <jats:sup>s<\/jats:sup>\n                      <jats:sub>PHQ-9<\/jats:sub>\n                      = \u2212 0.507). HRQoL more intensively declined in male (\u00df = \u2212 0.024,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.038) patients with an earlier age of onset (\u00df = 0.002,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.058). Higher progression of ataxia severity (\u00df = \u2212 0.010,\n                      <jats:italic>p<\/jats:italic>\n                      \u2264 0.001), mental health problems (\u00df = \u2212 0.012,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), and higher BMI (\u00df = \u2212 0.003,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.029) caused more severe decline of patients\u2019 HRQoL over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In absence of curative treatments, stronger focus on mental health and weight influence could help clinical evaluation and accompany treatment improving SCA patients\u2019 HRQoL, especially in male patients with early disease onset.<\/jats:p>\n                  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