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Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (\n                    <jats:italic>i.e<\/jats:italic>\n                    ., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (\n                    <jats:italic>i.e<\/jats:italic>\n                    ., a \u2018drop off\u2019 pattern). Twenty\u2010two ALS patients and 21 demographically\u2010matched controls completed verbal and nonverbal fluency tasks (phonemic\/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first \u2018initiation\u2019 and the remaining \u2018maintenance\u2019 time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (\n                    <jats:italic>e.g<\/jats:italic>\n                    ., waving). On phonemic fluency, ALS patients showed a \u2018drop off\u2019 pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS.\n                  <\/jats:p>","DOI":"10.1111\/jnp.12354","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T20:06:16Z","timestamp":1700856376000},"page":"265-285","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Verbal and nonverbal fluency in amyotrophic lateral sclerosis"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5385-5908","authenticated-orcid":false,"given":"Megan S.","family":"Barker","sequence":"first","affiliation":[{"name":"School of Psychology The University of Queensland  Brisbane Queensland Australia"},{"name":"Queensland Brain Institute The University of Queensland  Brisbane Queensland 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