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Read here for more advise, please:
https://steamcommunity.com/sharedfiles/filedetails/?id=3241230342
(I do use Load Accelerator, but nothing else.)
https://imgur.com/3kEefom
The problem then is the update itself, which has broken iPresentInterval and how vsync now works, which is somewhat avoidable in fullscreen mode by forcing settings through the driver, but windowed-mode is unaffected by driver settings and I can only recommend not using windowed-mode at the moment because of this.
https://imgur.com/cYAptIn
but not in borderless windowed:
https://imgur.com/3vKPXRK
I've made zero ini changes and all driver settings are default
If this helps then you can also set overrides for Fallout4.exe and Fallout4Launcher.exe in their file properties under the Compatibility tab. See there for High DPI override and set it to "Application".