I've applied last patch but still had problem (game freezes all the time) with Vista 32 bits, Ati Hd 5850, E8500 and last drivers (11.10 preview 2)
The problem was apparently specific with Ati graphic card.
The only fix working is to put this "atioglxx.dll" (see link to download) from older ati driver in rage folder (C:\Program Files\Bethesda Softworks\Rage)
http://dl.dropbox.com/u/11762729/atioglxx.dll
To resume: Apply last patch with http://support.amd.com/us/kbarticles/Pages/GPU122AMDCat1110PreDriverV2.aspx, put this atioglxx.dll in rage folder and that's all.
Personnaly, i set options with v sync disabled (cause i'm often under 60 fps), high aniso, small cach, 4x ...
Except strange textures behaviour, it's really smooth !
Good luck !
Sorry for my bad english i'm french
