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f there were a prize for the most inappropriate analytical technique in dementia research, "last observation carried forward" would be the runaway winner. As a society, we have spent millions of dollars on drug research in the hope of improving the care of the estimated 24.3 million people who have dementia worldwide. Researchers, patients and families have dedicated countless hours to carrying out trials to test the efficacy of drugs to treat dementia. We then take this invalu- able data and, in accordance with US Food and Drug Admin- istration regulation, subject it to last observation carried for- ward, a form of analysis that introduces bias. What is "last observation carried forward"? Drug trials are designed to follow patients over time to deter- mine the effect of the study drug. Participants often drop out before study completion. If these dropouts are not included in analyses, randomized trials can generate false results. Conse- quently, intention-to-treat analysis — the inclusion of all par- ticipants in the analysis according to the group determined at randomization — has become the standard for controlled tri- als. As part of this analysis, methods are used to estimate the missing data for patients who have dropped out. 1

Does analysis using "last observation carried forward" introduce bias in dementia research?