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Participants underwent baseline and 3\u2010year follow\u2010up cerebrospinal fluid (CSF) assessment of AD, neurodegeneration, astrocytic, microglial, and inflammatory biomarkers. Exposure to nitrogen dioxide (NO\n                      <jats:sub>2<\/jats:sub>\n                      ), particulate matter (PM)\n                      <jats:sub>10<\/jats:sub>\n                      , PM\n                      <jats:sub>2.5<\/jats:sub>\n                      , and PM\n                      <jats:sub>2.5<\/jats:sub>\n                      absorbance was estimated using land\u2010use regression models. Sex\u2010interaction and stratified analyses were performed. Mediation analyses evaluated cognitive and brain\u2010age outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Sex\u2010dependent associations were observed between air pollution exposure and CSF inflammatory and astrocytic biomarkers. Higher exposure was associated with longitudinal increases in glial fibrillary acidic protein (GFAP) and interleukin (IL) \u20106, primarily in women. GFAP partially mediated associations between air pollution exposure and worsening executive and attentional performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Findings support sex\u2010specific astroglial and neuroinflammatory susceptibility to traffic\u2010related air pollution in preclinical AD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>TRIAL REGISTRATION<\/jats:title>\n                    <jats:p>The ALFA+ study has been registered at ClinicalTrials.gov (10\u201006\u20102015, identifier: NCT02485730).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71837","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:00:24Z","timestamp":1791975624000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Air pollution is associated with sex\u2010specific longitudinal changes in astrocytic and neuroinflammatory processes linked to cognitive decline in Alzheimer's disease at\u2010risk individuals"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4935-6721","authenticated-orcid":false,"given":"Natalia","family":"Vilor\u2010Tejedor","sequence":"first","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Centre (BBRC) Pasqual Maragall Foundation  Barcelona Spain"},{"name":"Institute for Risk Assessment Sciences (IRAS) Department of Population Health Science Utrecht University  Utrecht Netherlands"},{"name":"Department of Human Genetics Radboud University Medical Centre  Nijmegen Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanca","family":"Rodr\u00edguez\u2010Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Centre (BBRC) Pasqual Maragall Foundation  Barcelona Spain"},{"name":"Institute for Risk Assessment Sciences (IRAS) Department of Population Health Science Utrecht University  Utrecht Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Genius","sequence":"additional","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Centre (BBRC) Pasqual Maragall Foundation  Barcelona Spain"},{"name":"Alzheimer's Center Amsterdam Amsterdam University Medical Center, VUmc  Amsterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Fern\u00e1ndez\u2010Bonet","sequence":"additional","affiliation":[{"name":"Barcelona\u03b2eta Brain Research Centre (BBRC) Pasqual Maragall Foundation  Barcelona 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