Why would this be “expected.” There can be a multitude of reasons a fraction of older, ailing trial participants might have “dropped out.”
Here are some reasons that come to mind.
Might any of the participants moved out of the trial area? After all, a lot of Alzheimer’s patients reside in family care-giver homes. They can move, without regard to a drug trial.
Alzheimer’s patients are elderly. They are susceptible any number of unrelated diseases and injuries, any of which could cause a patient to get sick and “drop out.”
In fact, a trial participant may have actually expired. Old people die.
Even if none of that is true, why, then, would “worst performing” patients be the only to drop out. Why would “best performing” patients stay in, and “worst performing” patients elect to drop out? Any evidence to support untoward reasons for “drop outs?” Why wouldn’t they be random, unrelated to “worst performance?”
If you're referring to slide 17 of the 2016 CTAD presentation http://www.anavex.com/my_uploads/CTAD-Anavex-December-2016.pdf, 5 patients were lost by the time Part A (5 weeks) was completed. There is no useful data from that. 2 were lost halfway through Part B. Maybe their results weren't great, and could be included, but it doesn't seem untoward to exclude dropouts halfway through the 52 weeks since their progress couldn't be represented. Your comment that 6 were "purposefully omitted" seems unfounded.
You are either conveniently overlooking or purposely neglecting that the dropouts were unrelated to the drug. Go do your homework... it's been posted several times in the past.