Snowcrash000: Setting a lower resolution and most of all turning off Windows Aero has improved my performance dramatically. I still get the occasional stutter, but much more rarely and they are over a lot quicker now.
OldFatGuy: You will always get the occasional stutter. The best computers at NASA would get an occasional stutter in this game, two areas are famous for it. Top of the catwalks on top of the Corvega Factory in Lexington is one. Top of buildings in downtown Boston area is the other.
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But I don't think that anyone plays this without any frame rate drops ever. It's just got some areas with a lot of detail to it and knowing Bethesda it probably isn't the most efficient engine ever made either.
I know you appeared to be comforting the OP for their frustration. But from a practical, technical point of view, what you wrote is not really true.
Frame rate fluctuates all the time. What truly matters is the minimum frame rate and - for a fast-paced shooter game - the range of the frame rate fluctuation may also matter. A frame drop from 250 to 120, or from 90 to 75... is fine, as it is still well above 60, meaning: most of us are unable to perceive the drop.
Since Fo4 is not a FPS shooter game, many players may want to turn on V-Sync or use the graphics driver to cap the frame rate to 60 - because higher than 60 does not help much with the gameplay. If so, you will not see meaningful frame drops again (unless you are using old, non-gaming hardware unable to keep the game running at 60).
Fallout 4 is already an *ancient* game in terms of the evolution generations of the computer hardware on which it runs. With a modern dedicated gaming computer, you should perceive no stutter from start to finish, even if playing Fo4 in 4K on ultra settings. And such a so-called gaming computer can be bought for less than US $1,000 nowadays. You may find one for as little as about US $600 if you shop on the US version of Amazon.com. That one should already be able to run Fo4 beautifully in 4K.
As for tips for OP -
In this case, hardware is the limiting factor, there is really no much else you can do on the software side. Nevertheless, here is the best you can do:
1) Disable all optional background programs/services (search Startup Apps using Windows' search bar)
2) Adjust Windows for best performance (search Advanced System Settings on the same bar; with this done, your Windows will look pale, flat, dull...)
3) Start the Fo4 launcher and minimize the settings (change resolution back to 1080p, disable AA)
4) Restart the computer
5) Don't run/start any other programs: Start Fo4 and play
6) Make sure your Fo4 is installed on the fastest hard drive you have (typically, this is C drive)
BTW, if your frame rate frequently drops below 30, this game is no longer enjoyable. It may still satisfy casual curiosity, but not much beyond that.
Happy gaming, and good luck!