Are you using Windows 10?
Fast alt-tab for me is usually a sign if the game is running in borderlesss window mode or Windows has activated the full-screen optimisations "feature" (which allows for faster alt-tabbing even when running the game in exclusive fullscreen mode) but for me in some games I get worse performance or stuttering when it's activated and usually just "disable full-screen optimisations" in the compatibility tab of the game executable if I notice performance issues/stuttering to make sure it runs in "true" exclusive full-screen mode. It might also explain the performance improvement if the game is now running in "true" exclusive full-screen mode instead of using the windows feature.
The only thing that has changed is the drivers not game settings. It exhibits it on all full screen games with the 18.12.2 drivers. An issue that didn't existed with previous drivers.