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There seems to be an issue with the latest Nvidia driver @AndrewT , and seems to have become a common theme over the last 2 weeks.
nvlddmkm.sys is the kernel mode driver and handles scheduling between the CPU and GPU, and is of course always active but doesn't really do a lot of work unless a compiled shader program is running ( as it handles hardware scheduling and GPU thread initialization ).
I am running the driver version just previous to the latest as I became aware of the issue before updating (I disallow auto-update) so I haven't messed with the latest driver. However, and this is a hypothesis with some speculation mixed in, that Nvidia is getting less and less keen on immediate mode OpenGL (which PA32.exe and PA64.exe both use).
Edit: Just to add, OpenGL immediate mode hasn't been supported for almost 13 years now, but has fortunately retained good legacy support among hardware vendors despite the disdain of such support from Kronos Group.