I often experience the Nvidia settings behaving unreasonably if you update the GPU drivers but do NO total reset (just installing over).
As I do not have any particular settings per game activated (only global settings -> Beware to reset all if you stored different Nvidia game profiles at the Nvidia settings control!) I'll just install fresh each time the GPU driver updates and had less trouble that way.
btw it's running more smoothly for me if I activate higher settings than lower. Often shadows make a big difference in terms of FPS but other effects somehow stutter the game more the lower they are set.
I'v just moved all to max and changed the visual effect max view distance as well as the normal render distance to be somewhat below 100% and it runs like a charm (depends on your CPU and GPU power for sure, and I bet also on your network speed and loss, and the name of your first born