I recommend you to update the medium preset manually depending if in the end of your intended modlist you still have great performance. These configuations present a medium general quality, to improve performance and to give more optimization, this doesn't mean you must play with medium quality of course.Even if i recommend the medium option, this doesn't mean you can't update. Go back to basic tab and select save and exit. Now untick the VSync option.On Details tab Lens flare, bokeh and motion blur unticked. On the launcher tick the Recommended Tweaks, then select Medium Preset.
Then open the application and select fallout 4 game. Overwrite if you have one yet.2.-Download the file and extract the BethINI folder into the Fallout 4 Main folder. Then Optimize your game with geforce experience or a similar program.- Download my file in this page and extract it to Documents/My Games/Fallout 4 folder. 1.- Start with a clean Fallout 4 installation (So delete all mods you had, the Documents/My Games/Fallout 4 folder if you have that and verify game cache with steam.