The last couple years of my mom's life, she had significant delusions, caused by Parkinson's related dementia.
Often with Parkinson's, the patient will deny their oppressive symptoms. For example, at the last Thanksgiving I spent with my mom, she repeatedly complained someone had hidden sand in her clothing (combined with Parkinson's being a movement disorder, she was weak, so moving was difficult. Don't mistake it as a joke, she was serious).
On the Saturday after, I was traveling with my brother when she called to see if we had things arranged for Thanksgiving (my immediate family has long been the host of a larger gathering of extended family, so it was on her mind, even though the day had passed and she was essentially bedridden in a facility).
With dementia, there's confusion mixed in, but when it's a delusion in the medical sense, there's not really much sense in trying to argue with it, because it's a literal concrete belief.
Before we moved her into the facility, there were times when she wouldn't eat because she was fretting about her grandchildren that had been turned into squirrels (why would you eat when that is going on).
My very first experience with her irregular thinking was arriving at her home in the morning and having her express relief that I could hear her, as the people she had been hallucinating visually all night were not saying anything she could hear. That was about 3.5 years before she died in hospice and a few months before a full blown psychotic episode.
Following the psychotic episode she had a stay in a psychiatric hospital and was discharged on Zyprexa, which was sedating and really dulled her personality. After changing over to Nuplazid, she had a good number of months of clear thinking, like the clock had been wound back to before any problems started, but it got to where she decided that the pills were the cause of her problems, culminating in another stay in the psychiatric hospital and my family placing her in memory care.
Eventually in memory care she broke her femur (balance problems, falling a lot), requiring surgery to pin the bone back together. In her delusional state, she decided that the pain she felt following the surgery meant that she couldn't stand up anymore, and she was bedridden for the remainder of her life. Physically, she probably could have stood up a couple days after the surgery, but she didn't want to.
I suppose dementia is a small corner of delusional thinking overall, but there you go.