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Don't bother reducing any of your settings - reduce your viewing area to 800x600 or 1024x768.
And definitely pickup the 275.27 nvidia drivers available here:

That's on windows XP.. Possibly snag the Directx 10 for XP files while you're at it.
Plays nice and smooth at 1024 x768 - only issue now is the infernal QTEs and the font being so darned small.
I am really surprised at the lack of polish and the demand for a high end system to play this game. really disappointing. Just glad I managed to get it running on my system; I really like the IP this stuff is based on.