Abstract： Objective To characterize the brain functional changes of amyotrophic lateral sclerosis(ALS)patients with various levels of cognitive impairment as measured by resting-state functional MRI(RS-fMRI).Methods From September 2013 to March 2017,a total of 55 patients diagnosed with ALS in Peking Union Medical College Hospital and 20 healthy controls(HCs)were included in this study,and all participants underwent neuropsychological assessments and diffusion tensor imaging scans.According to their cognitive performance,ALS patients were further subclassified into ALS with normal cognition(ALS-Cn,n=27),those with cognitive impairment(ALS-Ci,n=17)and ALS-FTD(n=11).Comparisons of fractional amplitude of low frequency fluctuation(fALFF)value and regional homogeneity(ReHo)value were conducted among the 4 subgroups.Results The fALFF showed significant differences in bilateral frontal lobe,left temporal lobe and cingulate gyrus,(P＜0.001,uncorrected)and the ReHo showed significant differences in left frontal lobe,right temporal lobe and left cingulate gyrus(P＜0.001,FDR corrected).The differences mainly stemmed from that patients with ALS-FTD showed decreased fALFF and ReHo in these areas when compared to the other three groups,especially in relation to HCs,mainly locating in left prefrontal lobe and anterior cingulate cortex.The whole-brain comparisons of fALFF and ReHo between ALS-Ci,ALS-Cn and HCs revealed no significant difference(P＜0.001,uncorrected).Conclusion Hypoactivities are detected in extramotor areas in patients with ALS-FTD.RS-fMRI is helpful in investigating the pathophysiologic mechanism of cognitive impairment in ALS.