There is no reason he can't have both. His father had Alzheimer's Disease and if you look at Trump's old interview videos, he used to be much more articulate and had a normal vocabulary. Now he substitutes words (oranges for origins), makes up new words like "bigly" (typical of people who have forgotten a word) and has the vocabulary of an elementary school student. He also seems to have some short term memory problems, which manifest as saying one thing and then reversing himself the next day. Then claiming he never made the first statement. He does have psychological problems, but I suspect there's something going on in his brain and it seems to be getting worse. Somebody competent in such matters needs to have a look.