I have a new computer.skyrim sets itself with nvidia to ultra settings. But with the mods im using it stutters when im lookking around in the world, SO i turn it down to medium settings. It is perfect now . But what about the 4 gig patch ? I hear different versions of, that it works or not and the use of the patch . Some say that it has no need to install it. What is thrut and why. Please explain to me ....

LAA at first was only usable by going to 3rd party programs via interwebs then Beth added it with 1.3 officially.

Well, I have a load of mods including very high detail texture ones and don't get much stuttering, mostly when it loads in a new area occaisionally when walking around.
I no longer get the purple game models either since the recent patch, so the engine has been improved a little since release too.
Could just be too much work for your GFX card and no amount of extra RAM usage is going to save it.

The third party LAA patch is no longer needed. It can cause problems now that Bethesda has included their own in the game.

As for game performance, you can try Skyboost or the ENB series patch (which may not work with 1.3, it did not for me). However, I do not use these and my game is smooth and stable with 1.3.

However, the first thing you need to do is see if the mods that you do have are compatible with 1.3. Also, have you tried the game with no mods installed? You can't get a modded game to run if the vanilla game is not running right and any performance results/stability issues are suspect when using mods.

So, have you tried the game unmodded?

It wasn't a patch so much as toggling a flag (a single byte) on the executable. Now this is toggled on anyway.

The stuttering is probably due to your video card running out of memory. How much memory does your card have?

Mine has 1gb and I use a ton of texture mods. On certain ones I have to select the slightly smaller textures because my card will run out of memory and start to stutter.

There are several tools you can use to see how much vram is being used. I'd find out and run it while playing on the settings that give you problems to see if that's the issue.

which begs the question, why wasnt this released much earlier?

i have nvidia g-force 550 ti. and on that card 1 gig ram

Legacy reason: Win XP 64bit.

it's most likely for the following reason:
deadline had to be met, not any small amount of time could be dedicated to set and test specific compilation tags for the PC version.

same reason the compiler optimisations where not checked.

since then, great modders proved to anyone that these simple tweaks could do miracles just by checking some boxes on the compiler.
now they had no more excuses to not include them and make the required minimal tests...

you have to understand that since without them the game still works (much worse but works nonetheless), in term of added financial benefits, it generate nothing but cost developper time.
15 years ago, gaming studio were mostly about creating great game and THEN get rich.
now, gaming companies are just another business, and the main goal is money. selling a game is just a means to an end, not the goal anymore.