It's both. I spent a decade in a relationship with someone who lied nearly continuously, it seemed to me that after a few years the lies they told became truths to them, no dementia involved. I made up this theory that their brain converted the lies to truths, because truths are easier to remember than lies, according to Judge Judy at least. So, in order to remember all the lies, they are converted to truths. imo.

After the relationship ended, my ex was eventually convicted twice for fraud, the second time they went to jail. I could go on and on with stories.

Trump's not even in control of his own brain, he's got serious mental illness.