Objective: Irisin, released by muscles during exercise, was recently identified as a neuroprotective factor in mouse models of Alzheimer disease (AD). In a cohort of AD patients, we studied cerebrospinal fluid (CSF) and plasma irisin levels, sex interactions, and correlations with disease biomarkers. Methods: Correlations between CSF and plasma irisin levels and AD biomarkers (amyloid β 1‐42, hyperphosphorylated tau, and total tau [t‐tau]) and Clinical Dementia Rating Scale Sum of Boxes (CDR‐SOB) were analyzed in a cohort of patients with Alzheimer dementia (n = 82), mild cognitive impairment (n = 44), and subjective memory complaint (n = 20) biologically characterized according to the recent amyloid/tau/neurodegeneration classification. Results: CSF irisin was reduced in Alzheimer dementia patients (p < 0.0001), with lower levels in female patients. Moreover, CSF irisin correlated positively with Aβ42 in both female (r = 0.379, p < 0.001) and male (r = 0.262, p < 0.05) patients, and negatively with CDR‐SOB (r = −0.234, p < 0.05) only in female patients. A negative trend was also observed between CSF irisin and t‐tau levels in all patients (r = −0.144, p = 0.082) and in the female subgroup (r = −0.189, p = 0.084). Interpretation: The results highlight the relationship between irisin and biomarkers of AD pathology, especially in females. Our findings also offer perspectives toward the use of irisin as a marker of the AD continuum. ANN NEUROL 2024;96:61–73 [ABSTRACT FROM AUTHOR]