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Alzheimer's disease (AD) has been linked to air pollution, especially particulate matter (PM). PM comprises various elements, including iron-rich particles that may reach the brain through inhalation. Lima, Peru is one of the most polluted cities in Latin America, with a high rate of AD. The study aims to evaluate the association between iron (Fe) trace elements in PM 10 and AD cases in Lima, Peru. This retrospective ecological study used monthly Fe concentration data from the Peruvian Ministry of Health. AD cases (ICD-10-G30) and dementia in AD cases (DAD, ICD-10-F00) were obtained from the Peruvian CDC. Fe trace element data were available for six districts in Lima for the years 2017-2019 and 2022. Cases were standardized based on ≥60-year-old populations of each district. Hierarchical mixed-effects models of Gaussian and negative binomial families were constructed to evaluate both outcomes jointly (AD + DAD) and separately (AD, and DAD). A sensitivity analysis was conducted by excluding data from Lima's downtown district. In the complete model, log-Fe concentration was associated with a higher rate of AD + DAD and DAD, and with a higher IRR for the three outcomes. After controlling for other metals, a higher DAD rate was observed (β-coeff = 6.76, 95%CI 0.07; 13.46, p = 0.048), and a higher IRR for AD + DAD (1.55, 95%CI 1.09; 2.20, p = 0.014) and DAD (1.83, 95%CI 1.21; 2.78, p = 0.004). The association was not significant in the sensitivity analysis. In conclusion, exposure to Fe through PM 10 inhalation may be associated with the presence of AD in Lima.