I've tried the patch, the shadow fix, updating and rollback of video drivers, the clamp and ipref changes, the downloaded *.dll from that New Vegas website, and etc.
Nothing I've found so far fixes it. The game otherwise, runs smoothly and quickly, even at high settings - it's just the movement makes the game very difficult to play.
The following is from DxDiag:
------------------
System Information
------------------
Time of this report: 10/23/2010, 13:09:26
Machine name: MARC-B0C2225142
Operating System: Windows XP Professional (5.1, Build 2600) Service Pack 3 (2600.xpsp_sp3_gdr.100216-1514)
Language: English (Regional Setting: English)
System Manufacturer: Dell Inc.
System Model: Precision WorkStation 380
BIOS: Phoenix ROM BIOS PLUS Version 1.10 A07
Processor: Intel® Pentium® D CPU 3.00GHz (2 CPUs)
Memory: 2046MB RAM
Page File: 871MB used, 3066MB available
Windows Dir: C:\WINDOWS
DirectX Version: DirectX 9.0c (4.09.0000.0904)
DX Setup Parameters: Not found
DxDiag Version: 5.03.2600.5512 32bit Unicode
------------
DxDiag Notes
------------
DirectX Files Tab: No problems found.
Display Tab 1: No problems found.
Sound Tab 1: No problems found.
Music Tab: No problems found.
Input Tab: No problems found.
Network Tab: No problems found.
--------------------
DirectX Debug Levels
--------------------
Direct3D: 0/4 (n/a)
DirectDraw: 0/4 (retail)
DirectInput: 0/5 (n/a)
DirectMusic: 0/5 (n/a)
DirectPlay: 0/9 (retail)
DirectSound: 0/5 (retail)
DirectShow: 0/6 (retail)
---------------
Display Devices
---------------
Card name: NVIDIA GeForce 8400 GS
Manufacturer: NVIDIA
Chip type: GeForce 8400 GS
DAC type: Integrated RAMDAC
Device Key: Enum\PCI\VEN_10DE&DEV_0404&SUBSYS_C7383842&REV_A1
Display Memory: 512.0 MB
Current Mode: 1024 x 768 (32 bit) (85Hz)
Monitor: Plug and Play Monitor
Monitor Max Res: 1600,1200
Driver Name: nv4_disp.dll
Driver Version: 6.14.0011.8618 (English)
DDI Version: 9 (or higher)
Driver Attributes: Final Retail
Driver Date/Size: 6/10/2009 06:03:00, 5908608 bytes
WHQL Logo'd: Yes
WHQL Date Stamp: n/a
VDD: n/a
Mini VDD: nv4_mini.sys
Mini VDD Date: 6/10/2009 06:03:00, 8087712 bytes
Device Identifier: {D7B71E3E-4744-11CF-587A-33E700C2CB35}
Vendor ID: 0x10DE
Device ID: 0x0404
SubSys ID: 0xC7383842
Revision ID: 0x00A1
Revision ID: 0x00A1
Video Accel: ModeMPEG2_C ModeMPEG2_D
Deinterlace Caps: {6CB69578-7617-4637-91E5-1C02DB810285}: Format(In/Out)=(YUY2,YUY2) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_PixelAdaptive
{335AA36E-7884-43A4-9C91-7F87FAF3E37E}: Format(In/Out)=(YUY2,YUY2) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_BOBVerticalStretch
{6CB69578-7617-4637-91E5-1C02DB810285}: Format(In/Out)=(UYVY,YUY2) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_PixelAdaptive
{335AA36E-7884-43A4-9C91-7F87FAF3E37E}: Format(In/Out)=(UYVY,YUY2) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_BOBVerticalStretch
{6CB69578-7617-4637-91E5-1C02DB810285}: Format(In/Out)=(YV12,0x3231564e) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_PixelAdaptive
{335AA36E-7884-43A4-9C91-7F87FAF3E37E}: Format(In/Out)=(YV12,0x3231564e) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_BOBVerticalStretch
{6CB69578-7617-4637-91E5-1C02DB810285}: Format(In/Out)=(NV12,0x3231564e) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_PixelAdaptive
{335AA36E-7884-43A4-9C91-7F87FAF3E37E}: Format(In/Out)=(NV12,0x3231564e) Frames(Prev/Fwd/Back)=(0,0,0) Caps=VideoProcess_YUV2RGB VideoProcess_StretchX VideoProcess_StretchY DeinterlaceTech_BOBVerticalStretch
Registry: OK
DDraw Status: Enabled
D3D Status: Enabled
AGP Status: Enabled
DDraw Test Result: Not run
D3D7 Test Result: Not run
D3D8 Test Result: Not run
D3D9 Test Result: Not run
-------------
Sound Devices
-------------
Description: SigmaTel Audio
Default Sound Playback: Yes
Default Voice Playback: Yes
Hardware ID: HDAUDIO\FUNC_01&VEN_8384&DEV_7690&SUBSYS_102801A8&REV_1022
Manufacturer ID: 1
Product ID: 100
Type: WDM
Driver Name: sthda.sys
Driver Version: 5.10.4823.0000 (English)
Driver Attributes: Final Retail
WHQL Logo'd: Yes
Date and Size: 11/16/2005 16:36:00, 1047816 bytes
Other Files:
Driver Provider: SigmaTel
HW Accel Level: Full
Cap Flags: 0xB5B
Min/Max Sample Rate: 44100, 44100
Static/Strm HW Mix Bufs: 1, 0
Static/Strm HW 3D Bufs: 0, 0
HW Memory: 0
Voice Management: No
EAX 2.0 Listen/Src: No, No
I3DL2 Listen/Src: No, No
Sensaura ZoomFX: No
Registry: OK
Sound Test Result: Not run
---------------------
Sound Capture Devices
---------------------
Description: SigmaTel Audio
Default Sound Capture: Yes
Default Voice Capture: Yes
Driver Name: sthda.sys
Driver Version: 5.10.4823.0000 (English)
Driver Attributes: Final Retail
Date and Size: 11/16/2005 16:36:00, 1047816 bytes
Cap Flags: 0x41
Format Flags: 0xCC0
-----------
DirectMusic
-----------
DLS Path: C:\WINDOWS\SYSTEM32\drivers\GM.DLS
DLS Version: 1.00.0016.0002
Acceleration: n/a
Ports: Microsoft Synthesizer, Software (Not Kernel Mode), Output, DLS, Internal, Default Port
Microsoft MIDI Mapper [Emulated], Hardware (Not Kernel Mode), Output, No DLS, Internal
Microsoft GS Wavetable SW Synth [Emulated], Hardware (Not Kernel Mode), Output, No DLS, Internal
Registry: OK
Test Result: Not run
-------------------
DirectInput Devices
-------------------
Device Name: Mouse
Attached: 1
Controller ID: n/a
Vendor/Product ID: n/a
FF Driver: n/a
Device Name: Keyboard
Attached: 1
Controller ID: n/a
Vendor/Product ID: n/a
FF Driver: n/a
Device Name: Dell USB Keyboard
Attached: 1
Controller ID: 0x0
Vendor/Product ID: 0x413C, 0x2010
FF Driver: n/a
Device Name: Dell USB Keyboard
Attached: 1
Controller ID: 0x0
Vendor/Product ID: 0x413C, 0x2010
FF Driver: n/a
Device Name: Dell USB Keyboard
Attached: 1
Controller ID: 0x0
Vendor/Product ID: 0x413C, 0x2010
FF Driver: n/a
Poll w/ Interrupt: No
Registry: OK
