Patients with frontotemporal dementia (FTD) exhibit marked changes in social and emotional functioning including lack of empathy, disinhibition, altered emotional reactivity, apathy and lack of insight. These changes are believed to be dependent on progressive frontal and temporal lobe degeneration. In this review, we discuss the nature of defective theory of mind and empathy in this group and relate it to regional dysfunction in the orbitofrontal and medial prefrontal cortex, based on evidence from several recent studies. The role of executive ability and co-existing emotional deficits are also considered.