IntroductionBehavioural variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by progressive dysfunction in social behaviour typically beginning in midlife (50s-60s). A hallmark of bvFTD is the loss of empathy for others, a symptom thought to be partially accounted for by a reduction in emotion recognition.1 Facial expressions are one way in which we communicate emotional information critical for successful social behaviour.2,3 Deficient facial expression recognition, particularly for negative expressions, such as fear and anger, is associated with inappropriate social behaviours. 4,5 Previous studies have demonstrated that patients with bvFTD with frontally or temporally predominant atrophy show deficits in facial expression recognition, while general face processing abilities, such as facial identity and gender discrimination are preserved. [6][7][8] Whereas a growing body of research has associated regions of atrophy with bvFTD clinical symptoms, to our knowledge, the Background: Frontotemporal dementia (FTD) is a neurodegenerative disorder resulting in social-cognitive deficits partially attributed to abnormalities processing social cues, such as facial expressions. However, to our knowledge, the functional neuroanatomy of deficient social cue processing in individuals with FTD has not been examined. The objective of this study was to delineate the functional abnormalities under lying altered facial expression processing in individuals with FTD using functional magnetic resonance imaging (fMRI). Methods: Patients meeting Neary criteria for behavioural variant FTD (bvFTD) with supportive neuroimaging and 18 age-matched healthy controls completed an implicit facial expression task during fMRI. We conducted volumetric brain morphometry to correct functional imaging data for volume differences. Results: We included 20 patients with bvFTD and 18 controls in our study. The results demonstrate emotion-specific functional abnormalities in frontal and limbic regions in patients with bvFTD. Patients also showed decreased activity in posterior ventral visual regions, specifically the fusiform cortex, possibly reflecting reduced afferent input from limbic regions. Finally, bvFTD was associated with increased activity in posterior regions, including the inferior parietal cortex. Limitations: Autopsy validation of frontotemporal dementia is not yet available for this cohort. Conclusion: Together, these findings suggest that fMRI combined with tasks targeting social-cognitive deficits is a powerful technique to objectively measure neural systems involved in emotion processing in individuals with bvFTD. As viewing emotional expressions is known to engage many of the same neural systems that are active when experiencing the emotion itself, fMRI during expression processing provides a novel window into the emotions of patients with FTD.