Looking really good now.
I found that I needed to let the game control the settings not the card so switched the AA and AS etc over to the game but left the CUDA-GPUs on all (not sure on the effect of that) and texture filtering set to quality etc. on the card.
Then in the first game settings screen I set the slider to 7/10, AS to x4 and ticked the multi-core then in the game options panel I ticked everything and set them all to high. I get very smooth frame rates, good AA, nice lighting and long draw distance with fine details.
It's the best it's ever looked.
IL2, FSX, ROF, SOW, Cliffs of Dover...
Vista Ultimate 64bit. Core2Quad9550 @ 3GHz, Nvidia 560Ti 1GB @ 1920x1080P, 4GB RAM, Creative SB X-FI